Location: Winchester,VA, USA
Quality Assurance Program Supervisor
Behavioral Health
The Quality Assurance (QA) Supervisor assures release of client information is performed in accordance with federal HIPAA requirements and that Grafton's policies related to records management are implemented. They promote compliance with Medicaid requirements for DD Waiver services through active monitoring and auditing and by providing consultation and training to those who manage and deliver DD Waiver services. The QA Supervisor Elevates the organization's use of critical root cause analysis (RCA) through conduct of RCAs following identified serious incidents.
Essential Job Functions
* Conducts monitoring and auditing activities to assure the completeness and integrity of client records. Provides direct feedback to users and managers on audit findings and assures identified errors are corrected. Supports health information management (HIM)/Records staff organization-wide through orientation, education, and sharing of relevant new or revised organizational and HIM practices. Manages sensitive documentation releases such as those involved in potential or active legal matters. Serves as an organization-wide resource on compliance with the Health Information Portability and Accountability Act (HIPAA).
* Conducts regular audits to assure documentation of Medicaid services, such as DD Waiver services, is completed timely, accurately, and in compliance with Medicaid regulations. Reports audit findings to managers and serves as resource for clarification of requirements. Monitors actions taken in response to audit findings to assure corrections are made and that errors of a specific type, as identified, do not continue. Develops and provides related training, as needed, to assure a shared understanding of Medicaid requirements by those providing services and their supervisors. Collaborates with the billing department to assure accuracy in billing of these services.
* Conducts Root Cause Analyses for targeted Level 1 serious incidents; conducts RCA for Level 2 serious incidents as needed in support of Quality Assurance Supervisors. Models the use of RCA techniques for others to promote the expansion of these activities
* Develops, as needed, specialized training related to HIM, quality assurance, and areas of compliance. Conducts trainings in these areas. Training may be site, program, regional, or organizational-wide in scope. Reviews Grafton's organization-wide training in HIPAA regularly and makes recommendations for any needed changes
* Actively serves on organizational teams or committees, as assigned, such as the Corporate Compliance Committee. May serve in a compliance role on workgroups or special projects to assure adherence to related regulations, quality assurance practices, and/or other applicable compliance/QA factors
* Completes and signs serious incident reports as assigned and communicates relevant information to Quality Assurance Supervisors. As part of this process, verifies other documents related to an incident have been accurately completed; this may involve documents such as nursing notes, body check charts, behavioral data, treatment plans, narrative notes, and service documentation. Enters data into Virginia's Department of Behavioral Health and Developmental Services (DBHDS) online serious incident management system in accordance with DBHDS requirements regarding timelines and content. Serves as back-up to the staff designated to maintain current serious incident information within Grafton's related tracking system
* Collects supporting evidence to demonstrate compliance with regulatory and accreditation requirements and submits evidence to external parties as needed. Serves as active member of team assigned to prepare for accreditation surveys, coordinating related activities, developing and providing related training, and actively participating during surveys.
* Serves as a lead or participant in periodic special projects, such as submission of required documents in support of new or atypical external reviews and monitoring activities such as Virginia's Quality Record Reviews and Home and Community Based Services reviews
* In support of Grafton's organization-wide medical services, conducts defined related audits, participates in standing and/or issue-specific meetings, works collaboratively with leadership in this area to assure compliance with Grafton's medical policies and procedures.
MINIMUM QUALIFICATIONS
* Requires a Bachelor's degree in Business, organizational leadership, health information management, human services (related field)
* 2 years, records management, auditing/monitoring, data management, or supervision of operations
EMPLOYEE BENEFITS
* Medical, dental and vision
* Flexible Spending & Health Savings Accounts
* 401(k), including an employer match
* Generous Paid Time Off plan
* Education Assistance
* Life Insurance
* Employee Assistance Program (EAP)
* Short-term disability (STD)
* Long-term disability (LTD)
* As Grafton is a 501(c)(3) non-profit, you may be eligible for federal student loan forgiveness
COMPENSATION
$51,896 - $65,000 Commensurate with on experience and qualifications
Grafton is an equal employment opportunity employer and tobacco-free workplace.
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