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Gary and Mary West PACE · 3 weeks ago

Quality Improvement and Compliance Analyst

1706 Descanso Avenue, San Marcos, CA 92078, USA

Full-time

Onsite

Mid, Senior Level

5+ years exp

Gary and Mary West PACE is a non-profit organization dedicated to providing high-quality, affordable health and support services to seniors. The Quality Improvement and Compliance Analyst will assist in maintaining regulatory compliance, conducting audits, and managing quality improvement initiatives within the organization.

Health CareHospital

Responsibilities

Assist to collect QI department data including that specified in the QI plan and required by state and federal regulations

Conduct medical records audits as Monitor participant medical records for complete and timely documentation

Responsible for maintaining regulatory compliance of all medical records within HIPAA standards

Ensure that participant medical record is retained for a minimum required period as outlined in GMWP policies and procedures

Participate in ongoing EMR trainings and subsequent learning opportunities on system enhancement/upgrades and related workflows

Assist in the development of training materials, training content, and topics for on-going EMR training based on chart review and input from leadership and users

Track and trend Service Delivery Requests, assuring that all regulatory timelines are met

Track and trend Grievances and Appeals, assuring that regulatory timelines are met

Assist the staff prepare for and successfully complete state and federal

Assist with PACE audits by preparing documents for desk review submission and, while auditors are on-site, assist the regulators navigate the EMR to access required information

Assist with audit plans and perform internal and external audits of workforce and provider compliance with federal and state regulations and all applicable contractual obligations

Facilitate the gathering and validation of data required to complete the annual HOS - M survey, with the goal of maximizing participation

Complete all required documentation in a timely and accurate manner

Protect privacy and maintain confidentiality of all company procedures and information about employees, participants and families

Follow GMWP policies and procedures and participate in any required Quality Improvement activities, staff training and meetings

Other duties as assigned

Qualification

Electronic Medical RecordHIPAA PrivacySecurityPACE regulations knowledgeData managementMS Office SuiteAnalytical skillsCustomer service skillsOrganizational skillsCommunication skillsLeadership skills

Required

Bachelor's degree in related field or 5 years of experience working in Program of All-Inclusive Care for the Elderly (PACE)

Experience with managing data and conducting analyses using productivity suite software including complex spreadsheets and preferably relational and/or hierarchical databases

Possess knowledge of HIPAA Privacy and Security

Possess knowledge of state and federal PACE regulations and contractual requirements

The ability to meet deadlines and manage tasks accordingly

Must possess strong analytical and organizational skills, as well as professional verbal and written communication skills

Ability to work independently with minimal supervision and ability to multi-task

Competence in use of computers for business analysis and communication

Ability to exercise strict confidentiality with all aspects of the position

Demonstrated ability to work and communicate effectively with employees at all levels

Proficiency with MS Office Suite, Word, Outlook, PowerPoint and Excel

Ability to process accurate information in a timely manner

Excellent leadership, organizational, customer service and communication skills with seniors, their families and interdisciplinary team members

Highly motivated, self-directed, able to execute tasks in a quickly changing environment and make sound decisions in emergency situations