Consultant- Quality Assurance Analyst

About Us:

NYSTEC is a non-profit technology consulting company, advising agencies, organizations, institutions, and businesses since 1996. Were independent and vendor-neutral so we have our clients best interests at heart. At NYSTEC, we know that we succeed when individuals and teams flourish personally and professionally, so our benefits and perks support this mindset. Are you ready to contribute to our engaged workforce and deliver the NYSTEC Experience?

About the Role:

The New York State Medicaid Health Home program was designed to serve eligible New Yorkers experiencing healthcare barriers in obtaining the care and services they need to stay healthy. A Health Home is a group of health care and service providers responsible for integrating and coordinating all primary, acute, behavioral health, and long-term services and supports for eligible members. After the initial three-year designation period, the Department of Health and its state partners conduct collaborative reviews of quality and performance measures to determine if Health Homes across the state qualify for redesignation.

As a quality assurance analyst, you will collaborate with team members to conceptualize, deliver, and support our clients through todays ever-changing healthcare landscape. Your day-to-day role as a consultant will be providing quality assurance analysis expertise to evaluate the qualifications of the Health Homes for designation/redesignation status across New York State.

Key Responsibilities

• Evaluates Health Home Redesignation cases for compliance to applicable regulations.

• Communicates evaluation requirements and follow up clearly.

• Evaluates documentation against applicable regulations.

• Collects data and documentation to support compliance findings.

• Uses technology to convert hard copy documentation to electronic version and submits via secure file transfer.

• Records and summarizes compliance findings for the Health Home program.

• Assists in determining trends in non-compliance.

• Makes appropriate and timely recommendations to project management.

• Supports ongoing operationalization of Health Home Redesignation processes and procedures. This includes developing first-rate quality assurance deliverables, templates, and reports, establishing quality control processes and standard operating procedures (SOPs), and adhering to quality assurance best practices.

• Coordinates with quality assurance team to respond to ad-hoc internal and external requests.

• Collaborates with quality improvement lead to ensure cross-domain collaboration on program tools, processes, procedures, templates, and deliverables.

• Builds and maintains relationships with stakeholders to provide outstanding customer service.

• Coordinates as needed to schedule onsite visits.

• Travels, as required, to complete on-site reviews on an ongoing basis by region within New York state.

About you:

Required Qualifications

• A minimum of 4 years experience as a registered nurse (RN), licensed mental health counselor (LMHC), licensed clinical social worker (LCSW), care manager, or healthcare compliance analyst, in a role working with critical care providers, public health providers, or providers that care for children, older adults, persons with traumatic brain injury, persons with emotional disturbances, or persons with developmental disabilities .

• One year of experience with monitoring compliance or fee-for-service (FFS) Medicaid or managed care billing.

• Experience with compliance audits or chart reviews.

• Exceptional customer service relationship techniques, including superior verbal and written communication skills .

• Excellent attention to detail in completing assigned tasks.

• Proficiency in Microsoft Excel, Word, Outlook, PowerPoint and SharePoint.

• For this role, travel is required approximately 10% of the time. Work can be completed remotely as needed.

Preferred/Desired Qualifications

• Working knowledge of Health Homes Redesignation program, including a firm understanding of the redesignation process and requirements.

• Experience working with eMedNY, Child Adolescent Needs and Strengths (CANS-NY), Uniform Assessment System for New York (UAS-NY), Medicaid Health Homes, Medicaid Managed Care Organizations (MMCOs), and/ or other related systems/programs/organizations.

• Knowledge of New York State Medicaid billing practices/systems.

• Experience with Electronic Health Record (EHR) systems.

• Experience working with Office of Mental Health (OMH), Office for People with Developmental Disabilities (OPWDD), and/ or Office of Children and Families (OCFS).

• Ability to work with and relate to staff and demonstrate active listening skills.

• Process oriented and results-driven work strategy.

• Ability to foster teamwork with all levels of management and staff.

• Ability to work well independently and within a team.

• Experience in meeting deadlines and adhering to strict standards.

Education and Experience

• A bachelors degree in healthcare or public health study, with at least 2 years of related experience is required. An equivalent combination of advanced education, training, and experience will be considered.

The pay range for this position is $60,334.00 to $82,959.80 per year.

It is NYSTEC's policy to provide equal employment opportunity (EEO) to all individuals, regardless of actual or perceived race, color, creed, religion, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), age, national origin, ancestry, citizenship status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, military service and veteran status, sexual orientation, marital status, or any other characteristic protected by local, state, or federal laws and ordinances. NYSTEC is strongly committed to this policy and believes in the concept and spirit of the law.

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please contact recruitment@nystec.com if you require a reasonable accommodation to apply for or to perform this job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Applicants must be authorized to work in the United States without the need for visa sponsorship now or in the future.

Learn more about NYSTEC by visiting www.nystec.com.