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Quality Assurance Auditor

3 months ago

Red Oak, United States Nishna Productions Full time
Job DescriptionJob Description

This is a full time position at our Administration Building in Red Oak, Iowa. The hours are Monday- Friday 8am-4:30pm.

Nishna Productions, Inc.

Job Description

Quality Assurance Auditor

I. The Quality Assurance Auditor is responsible to the Quality Assurance & Safety Specialist.

II. This is a full-time, non-professional level position.

III. Specific Job Duties & Responsibilities:

  1. Complete Medicaid compliance activities, which may include but not be limited to:
    1. Completion of audit functions for all Medicaid reimbursable services.
    2. Before billing perform audits on hours billed against documentation.
    3. Check documentation, against time sheets, against billing.
    4. Check day services attendance sheets against documentation/data sheets and units billed.
    5. Assist Quality Assurance & Safety Specialist with checking documentation and data collection for technical accuracy.
    6. Document findings and report any errors needing to be corrected to the Executive Director, Director of Operations, Director of Residential Services, and the billing department.
  2. Assist with case records review as directed.
  3. Assist with client Satisfaction Surveys as assigned.
  4. Maintain the current funding chart/spreadsheet for tracking client funding authorization dates and other pertinent client data. Responsible for keeping this system updated in all areas.
  5. Maintain a system to track funding authorizations within the SetWorks system for all clients. Enter all funding into SetWorks. Responsible for keeping all funding information updated in all areas.
  6. Learn how to navigate all Managed Care Organization portals. Responsible for checking portals to keep client tracking system updated, as well as to verify Medicaid eligibility for clients.
  7. Maintain a tracking system to track how and when clients who have community jobs report their monthly earned wages to Social Security. Ensure that all monthly wages are reported for clients who receive both hourly and daily SCL services.
  8. Serve as a co-manager of the agency’s electronic documentation system.
  9. Assist with reporting all Critical Incident Reports to IMPA and Managed Care Organizations when required.
  10. Monitor the websites of all Managed Care Organizations for information needed by Nishna Productions, Inc. to ensure all training and requirements are met.
  11. Provide Medicaid Compliance & Documentation training to all new employees if the QA Specialist is not available. Provide classes for any new employees. Additionally, provide any refresher training in these areas to all employees as required.
  12. Assist with the maintenance of the SetWorks software system.
  13. Maintain and track supplies that may be needed on a monthly basis at the admin building.
  14. Complete all other duties as assigned by the Executive Director and Quality Assurance and Safety Specialist.

V. Qualifications/Requirements:

  1. High school diploma, with post-high school secretarial/bookkeeping experience preferred.
  2. Prefer background in human services field.
  3. Prefer previous experience and knowledge in Medicaid funded services.
  4. Experience in computer use and word processing.
  5. Proficient in Excel, Word, and SetWorks.
  6. Above-average organizational and communication skills.
  7. Must be able to perform accurate audit and record-keeping duties.
  8. Must be able to maintain confidentiality.
  9. Must be responsible and self-motivated.
  10. Must be able to adapt to changes in schedule with little or no notice.
  11. Individuals "must not have or be a carrier" of a serious infectious or communicable disease, such as but not limited to, incurable, fatal, or debilitating diseases which cannot be eliminated or reduced by reasonable accommodation. A current example would include, but not be limited to, tuberculosis. Determination of the existence of a serious disease is to be made by the proper medical authorities.
  12. Must not have been legally convicted of any type of abuse, assault or bodily injury.
  13. Must be willing to work with others as a team to accomplish tasks.
  14. Demonstrate the ability to work under pressure to meet billing deadlines.
  15. Flexibility in scheduling of hours worked is needed.

VI. Essential Functions:

  1. Every employee/volunteer of Nishna Productions, Inc. is on a need-to-know basis regarding the Protected Health Information (PHI) of the individuals they serve. Therefore, a security clearance level is assigned for each job description and those security levels are allowed access only to the information required to complete the duties in each position.
  • Level One allows the least access and is intended for truck drivers, maintenance staff, redemption center workers, and volunteers.
  • Level Two is for direct care workers including floaters/substitutes, SCLS, Program Instructors, Day-Hab aids, Vocational Trainers, lead staff, and 1:1 staff.
  • Level Three includes the office support staff.
  • Level Four is for Team Leaders, supervisors, and Work Center Supervisors.
  • Level Five is the security clearance given to Program Coordinators.
  • Level Six allows access to all PHI and includes Directors/Administrators, Quality Assurance, and IT staff.
  • Temporary clearance for PHI access can be given if staff require access to complete extra assigned duties (i.e. filling in for another department). Maintenance personnel are given permanent access to areas where PHI is stored but they may need to enter in order to complete their duties.
  1. Ensure that all audit findings remain confidential and are reported to the Director of Operations, Director of Residential Services, and the Executive Director.
  2. Completion of quality assurance-related activities for services delivered by the agency.
  3. Know Home & Community-Based Services, Department of Inspections & Appeals, Habilitation, and Community Support Program rules and regulations.
  4. Act as a leader and role model at all times.
  5. Complete all required paperwork.
  6. Represent the agency to the public, including persons served, referral sources, funding sources, licensing entities, and parents & guardians.
  7. Be an active participant on various agency committees and teams.
  8. Be flexible in handling assigned job duties. Be flexible in hours worked. Be available to work when necessary. Must be willing to work at least 40 hours per week.
  9. Work in collaboration and consultation with agency staff to ensure the provision of high-quality services.
  10. Ability to complete electronic documentation.

VII. Physical Requirements:

1) Must be able to travel between various agency locations.

2) Must be able to carry necessary paper and supplies to perform functions.

3) Must be able to lift up to 55 pounds.