QA Specialist Health Homes

• FLSA: Non-Exempt
• Reports to: Long Term Services and Supports Manager Longview
• Supervisory Responsibilities: None
• Pay Grade: 19

SUMMARY:

Conducts AAADSW’s quality assurance and contract monitoring reviews for the Health Home program while consulting with program leadership on ongoing planning and improvement activities; represents HCA for grievances; and serves as the ProviderOne subject matter expert, ensuring program billing is supported in related systems, working closely with the fiscal team and Managed Care partners.

ESSENTIAL FUNCTIONS:

• Conduct quality assurance monitoring for the Health Home program across AAADSW’s regional service area(s), including but not limited to DSNP and CCO audits for all contracted providers.
• Communicate and collaborate with the LTSS Director and LTSS Program Manager on compliance monitoring trends by way of report generation and analysis.
• Participate as requested in Health Home Lead and CCO network meetings.
• Review subcontracted Care Coordination Organizations for contract compliance, in coordination with the Contracts Team.
• Collaborate with the LTSS Program Manager on training materials and presentations to the Care Coordination Organization network.
• Communicate and problem-solve effectively with colleagues at all levels of the organization.
• Co-facilitate HCA’s Health Home in-person training for the network.
• Train the CCO network on the HAP Database and provide technical assistance.
• Collaborate on requests for public records of Health Home participants.
• Serve as the primary liaison for the management of, research on, and communication with fiscal regarding payment discrepancies with Lead entity billing activities.
• Confirm CCO billing has the necessary supporting documentation.
• Act as the Health Action Plan subject matter expert and provide guidance to staff as needed in data entry in the HAP database.
• Review, create, and process reports and documents necessary for HH Lead compliance.
• Review, approve, and log CCO network Tier exceptions.

WORKING CONDITIONS AND PHYSICAL EFFORT:

• While performing the duties of this position, the employee is regularly required to talk, hear, stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls, and reach with hands or arms.
• The employee occasionally lifts or moves up to 20 pounds.
• Specific vision abilities required by this job include close vision and the ability to adjust focus.
• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
• Work is normally performed in a typical interior/office work environment.
• When attending meetings or community events, the employee travels by automobile and is exposed to changing weather conditions.