Collaborative for Children & Families · 1 day ago
Director of Quality Improvement and Compliance
New York, United States
Full-time
Onsite
Lead/Staff, Director/Executive
5+ years expThe Collaborative for Children and Families (CCF) is a non-profit organization focused on serving children and families in the downstate region of New York. They are seeking a Director of Quality Improvement and Compliance responsible for overseeing the Quality Improvement Department, ensuring adherence to program administration and compliance with regulations and standards.
CommunitiesHealth CareMental HealthNon ProfitPrimary and Urgent Care
Responsibilities
Work under the direction of the Chief Operating Officer to ensure compliance and adherence to state and local policies are monitored in accordance with guidance and regulations
Ensure that the Health Home CMA network is monitoring progress towards achieving performance measures for children such as NCQA, NYS HEDIS and QUARR measures that monitor quality of care
Ensures the Health Home CMA network is adhering to NYS DOH Health Home policies and standards by conducting routine audits, investigations, and data analysis
Designated Compliance Officer for any OMIG self-disclosures, investigations or reporting of Fraud, Waste and Abuse (FWA) as well as any HIPAA risk assessments
Implement CQI methodologies thought the organization and network
Execute and maintain compliance with CCF’s Compliance Plan
Prepares regular status reports on the performance of the programs and on any issues that may require additional oversite or attention
Serves as the lead contact for all external oversite entities for audits and responsible for responding to and implementing any changes needed for corrective action plans/ performance improvement plans
Undertake special projects and prepare special reports as assigned by Executive Management
Provide back-up assistance to other contract staff
Oversees the development of compliance policies, procedures, and programs; provides continuing guidance on compliance matters and compliance standards to the CCF Health Home CMA network
Coordinates and collaborates with other department heads with creating and implementing corporate policies
Ensures compliance policies and programs are comprehensive, current and reflect Professional’s business practices
Develops measurement tools to measure quality performance, conducts internal compliance chart reviews; Investigating complaints: When a compliance issue arises, Director investigates the matter to identify the root cause and recommend corrective action, and develops corrective action plans
Maintains professional and technical knowledge of health care internal audit process
Review and approve all marketing materials and other business communications as necessary to ensure compliance with applicable regulations
Investigate complaints and coordinate actions plans with other departments; compiles reports of calls received, investigations conducted, findings and recommendations developed, action plans established, and progress noted
Qualification
Required
Master's degree with a minimum of 5 years of experience in Public Policy/Administration, Sociology, Management, Statistics, Data Science, Economics, or related field
A minimum of 2 years of direct supervision and management of individuals and teams
Knowledge of Office of Medicaid Inspector General (OMIG) rules and regulations
Experience managing large data set with Excel, creating pivot tables, using sorting/filtering criteria and creating reports for presentation to executive leadership
Comfortable with Billing Data Concepts (Accounts Receivable, Claims, Remittance, Denials, etc.) as it relates to Medicaid billing
Knowledge of the NYS Medicaid eligibility requirements and benefits
Knowledge with government contract billing and reimbursement
Ability to manage overview of billing workflows
Comfortable in a wide range of technology and systems
Preferred
Certified Healthcare Compliance Professional preferred
Certified Microsoft Power BI (PBI) preferred
Knowledge and understanding of Medicaid Billing preferred
Preferred understanding of NYS Health Home service concepts being provided in relationship to billing requirements
Preferred knowledge of developing queries or dashboards in an interactive database such as Microsoft Power BI, Tableau, etc
Excellent time management and documentation skills
General math skills with particular attention to detail
Microsoft proficiency: Word, Excel, PowerPoint
Able to work well with colleagues in order to identify, resolve and share information regarding the billing process
Able to handle expected volume of work/quickly resolve problems and escalate appropriate problems to management
Adapts well to change
Excellent communicator with good interpersonal skills
Ability and willingness to attend workshops/trainings/webinars upon request
Accepts responsibility for accuracy of data
Ability to work independently with little supervision
Applies common sense understanding to carry out detailed but uninvolved written or oral instructions
Company
Collaborative for Children & Families
Founded in early 2014, the Collaborative for Children and Families (CCF) was formed in anticipation of changes in the delivery of health care services to children eligible for New York State’s Medicaid program.
2-10 employees
Funding
Current Stage
Early StageLeadership Team
Alyssa Paulozzo, MSP
Chief Operating and Compliance Officer
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