QUALITY ASSURANCE ASSOCIATE

Job Summary:

This position is responsible for a variety of functions related to Quality Assurance and administrative support. Performs all responsibilities in compliance with COA standards and state, federal, agency and all other applicable rules and regulations, and Wernle policies and procedures. This position is also responsible for functions related to Medicaid coverage. Verification and notification of eligibility, benefits and/or prior authorizations and providing notification to ensure reimbursement for therapy services rendered. This position routinely works with HSPP, therapists, case managers, case workers, nurses, financial advocates, and patients to resolve issues that arise during the prior authorizations process.

Position responsible for managing control center, monitoring cameras and programming and documenting accordingly.

Essential Duties and Responsibilities:

• Verifies and accurately documents Medicaid benefits
• Obtains and documents prior authorization approval from Medicaid for diagnostics and therapy
• Works in transit with the Quality Assurance Manager and notifies the appropriate parties when authorization is not obtained and/or benefits are inadequate.
• Audits documentation before submission for billing and follows the procedure for notification regarding returned documentation
• Operates the switchboard during business hours
• Perform clinical audits on residential and outpatient documents ensuring compliance with Medicaid, DCS, and COA
• Takes and transcribes meeting minutes
• Assists with requests for information
• Prepare and maintain COA standards through monitoring of emergency drills and yearly surveys
• Develops and maintains positive and professional relationships with residents, staff, referral agencies, and other community offices / departments as agents of Wernle Youth and Family Treatment Center.
• Obtains thirty-two (32) hours of continuing education credits per year
• Performs other duties as assigned

Education and Experience:

• Basic knowledge of accounting, word processing and spreadsheets.
• Demonstrated critical thinking and ability to analyze information and problem solve
• Demonstrated ability to provide clear and professional verbal/written communication skills
• Ability to work independently within a team setting
• Ability to adapt to a dynamic work environment
• Demonstrated ability to prioritize and manage a large workload in stressful situations
• Familiarity with diagnostic impression terminology
• Demonstrated ability to complete work with a high level of detail and accuracy
• Ability to meet process time standards
• Ability to provide professional and courteous service in all interactions with internal and external customers
• Ability to navigate through various software applications
• Ability to navigate and maneuver through multiple web sites particularly Web Interchange.
  
  

Certificates, Licenses, Registrations:

Two years experience in a health care setting or equivalency. Previous experience with medical insurance and prior authorizations.