CQI / Medicaid Coordinator Job – Tuskegee, AL 41061

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Why You'll Love This Job

Medicaid Coordinator coordinates standards accreditation for DYS. Conducts risk management and training efforts under the direction of the Executive Director. Prepares risk management pre and post testing summaries and documents to demonstrate quality and service quantity of delivery. Performs DYS Admissions and functions. Oversees all Medicaid documentation and the meeting of Medicaid guidelines as well as chart audits.

Responsibilities

  • Requires extensive. Knowledge and experience with standards of care including regulatory standards of Alabama,DYS, Medicaid, SACS, and Sequel TSI and other contractual agreements so as to ensure program policies, procedures, and practices comply with standards of these entities.
  • Coordinating the development and revision of departmental CQI indicators and monitoring of the measurement/ reporting process.
  • Responsible for review and analysis of collected data from the program’s reporting systems. Communicating this information through both wwritten and oral presentations to the Program Management and committees.
  • Developing and generating required reports.
  • Conducting and/or coordinating special studies as identified and needed.
  • Conducting special investigations as directed by the Executive Director or as prescribed by policy and procedure. For example, student/staff injuries during containments, allegations of abuse and/or neglect, and unresolved grievances. Assist in the required program reporting process with outside entities.
  • Conduct and/or coordinate staff training regarding standards of care and the program’s CQI monitoring/reporting systems.
  • Serves as the recorder for all Management and Safety Committee and Advisory Board meetings. Prepares minutes for said committee or meeting.
  • Remain knowledgeable of changes in financial billing and documentation requirements concerning Medicaid service delivery and reimbursement.
  • Perform chart reviews weekly in compliance with the established RAC plan.
  • Provide weekly updates to Executive Director of audit findings with a Corrective Action Plan in place.
  • Maintain a master schedule of service due dates and notify clinical staff of approaching documentation deadlines.
  • Verify Medicaid eligibility via the Alabama Medicaid Website.
  • Prepare and submit billing spreadsheets and summaries to OSC Accounting on a monthly basis by the 10' h of each month for DYS.
  • Coordinate with OSC Accounting and responsible third-party sources to resolve coverage and claim issues including verification of coverage.
  • Communicate with county Social Workers, JPOs, or DYS Medicaid personnel as requested to resolve billing or treatment related issues.
  • Other duties as assigned by supervisor and/or Executive Director.
  • Adheres to the policy and practice concerning issues of creation, editing, transmission, storage and disposition of all Protected Health Information (PHI) of Sequel Youth & Family Youth Services.
  • Support by action and example the Sequel TSI Creed.

Qualifications

  • Education: High School Diploma or GED
  • Experience: One-year or more experience in quality assurance/improvement processes and experience related to ACA, etc. standards or equivalent combination of education and experience
  • Computer Skills: Basic computer skills, including usage of email, Internet Explorer, and print documents.
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