QI Tech Specialist - hh513601

QI Tech Specialist-HH513601

Under the general supervision of the Pathways to Wellness Associate Vice President, the Quality Improvement Specialist provides program Quality Assurance and Improvement oversight, which includes operational procedures, outreach and compliance. The Quality Improvement Specialist implements quality improvement systems, data analysis, and program processes.

Essential Job Functions:

• Pull Revenue Cycle Management reports to monitor enrollments, entitlements, and collections to maximize revenue.
• Reviews a weekly billing report detailing denials, inconsistencies with documentation and service billed, and clients with no billing for the month.
• Ensure that billing is submitted in a timely manner with the appropriate rate code (Adult Homes, HH, HH plus, AOT, Outreach etc.).
• Ensure clean claims are prepared and works with Finance to ensure all billing denials are addressed by identifying Medicaid eligibility issues, incorrect CIN, DOB, etc. and needed corrections are accurately reflected in the corresponding EHR.
• Navigate health information systems such as Foothold, Cx360(CORE), MAPP, ePaces and PSYCKES to enhance outreach and engagement strategy planning and data informed care.
• Translates data into actionable information for direct care staff and leadership to facilitate data informed care and performance improvement.
• Assist with revenue cycle management, including billing submission, tracking and reconciliation of unpaid claims.
• Conducts data analysis and reporting to support program operations and to meet reporting requirements of funders/payers. Ensure timely submission of reports to appropriate oversight/funding organizations.
• Defines policy, procedures and program standards to ensure internal program compliance with federal, state, city and agency requirements.
• Communicate effectively with referral sources, Managed Care Plans, OMH, DOHMH, DOH, and other providers regarding referral, enrollment, and authorization for services/ level of service determination.
• Review internal and external audits to maintain DOH and Non-Medicaid policies and procedures.
• Cultivates effective relationships with internal ICL programs (Clinics, Housing, Residential treatment and more) to ensure adequate service delivery.
• Develop workflows to map program processes for referral enrollment, billing, reporting and quality improvement measures. Design and maintain performance management system to monitor and improve productivity, compliance and quality.
• Assist with specialty projects, outreach efforts, community events, member engagement and presentation to increase the census of programs as it relates to revenue improvement.
• Quality wellness checks via telehealth and field visits.
• May be assigned other tasks and duties reasonable related to job responsibilities.

Essential Knowledge, Skills and Abilities:

• Committed to equity, diversity, inclusion and belonging, and active promotion of the ICL values and goals.
• Proficient in Excel formulas and functions (v lookup, pivot tables, etc).
• Knowledge of agency policies, program policies, procedures and functions.
• Team player able to work efficiently multi-disciplinary team.
• Ability to provide administrative support to program staff.
• Excellent oral and written communication skills.
• Skilled at data manipulation and visualization.
• Ability to design and maintain electronic filing system.
• Ability to design for the collection of information.
• Ability to prioritize and follow through on multiple tasks simultaneously
• Organized, independent and personable.

Qualifications and Experience:

Bachelor's degree and three years of clinical and database experience. Master's degree in human services area preferred. Must have extensive experience using multiple databases, and proficient in Microsoft Word, and Excel.