Quality Assurance Coordinator chez Abode Services

Abode, one of the largest and effective nonprofits working to end homelessness in the Bay Area, is seeking a Quality Assurance Coordinator for our programs in Solano County.

About The Role: The Quality Assurance Coordinator will supervise the Billing Coordinator while providing support and assistance to the Program Manager, Clinical Supervisor, and other administrative staff to ensure clinical and quality assurance and improvement of billing and data systems, charts, electronic health records, etc.  

The People and Culture: You will be surrounded by some of the most talented, supportive, smart, and kind leaders and teams - people you can be proud to work with! Abode Services regularly recognizes employees’ efforts, seeks employees’ input, and cares for employees as people with lives outside of work. We believe that we make better decisions and provide quality services when our workforce reflects the diversity of the communities in which we operate. People of color make up nearly 70% of our workforce and we strive to recruit and retain employees from all backgrounds. 

Our Benefits & Perks:

• $70,000 - $85,000 annually DOE
• 100% paid health, vision, and dental options
• 19 PTO days & 12 Holidays per year
• Voluntary benefits: FSA, EAP, Commuter Checks, Life Insurance, Legal, and more
• 3% retirement match/contribution 
• Professional Development Trainings and Opportunities, Leadership Academy Programs, and All Staff Events
• Dynamic, mission-driven culture and supportive leadership. We support you in supporting others

How You Make An Impact: 

• Supervise Billing Coordinator. 
• Assist in planning, organizing, developing, evaluating, and when necessary, revising Utilization Review processes. 
• Maintain outcome data for the agency that includes the following: examination of aggregate data on outcomes and identification of potential problems and/or patterns of outliers. Develop a data/billing/evaluation plan, which lays out what systems, processes, and other infrastructures are needed to better manage our data systems and then use the data to inform the efficacy and evaluate our delivery of services. 
• Develop outcome reports and present data for distribution. Assist in the evaluation of program outcomes and in preparing reports on program outcomes. 
• Assist Clinical Supervisor and Program Manager in internal monthly audits of charts (CQRT), looking for accuracy, completion, quality, and compliance with internal and external regulations; provide summaries and feedback to managers; identify and follow up on plans of correction.   
• Work with county representatives to ensure Abode complies with Medicare and Medi-Cal utilization review regulations. 
• Provides information on Medicare and Medi-Cal Utilization Review requirements to clinical, supervisory, and management staff. 
• A willingness to become the subject matter expert in Medi-Cal regulations and the policies/procedures of each of our contract counties is a must. 
• Participate with staff in utilization and quality improvement meetings and projects. 
• Compile, track, and review denied services; represent Abode in appeal of any adverse decisions. 
• Oversee the process for new and closed charts including tracking, printing, filing, and storage. 
• Provide support to direct service staff in the efforts to complete charts by specified deadlines and to meet Medi-Cal standards. 
• Ensure compliance with HIPAA requirements. 
• Work with County Staff to obtain staff IDs and inform managers of changes in county policy and procedures. 
• Responsible for training new staff on office policies and protocols related to quality assurance and improvement. 
• Establish and maintain positive, collaborative relationships with program staff. 
• Assist the Program Manager, Clinical Supervisor, and other staff as needed. 
• Other duties as assigned.

How You Meet Qualifications: 

• Bachelor's degree in psychology, Human Services, Social Work, Sociology, or related field or equivalent Quality Assurance experience 
• Two years of experience in the Medi-Cal utilization review process.  
• Work flexible hours, including occasional weekends and evenings when required. 
• Reliable transportation and proof of a valid and current California Driver’s License and current insurance along with a clean DMV record required.   

Competencies: 

• Excellent verbal & written communication, organizational, and time management skills. 
• Strong analytical and problem-solving skills with meticulous attention to detail. 
• Experience in and expansion of a solid understanding of county billing systems, data systems, and Electronic Health Records systems.   
• Experienced knowledge of health care laws and regulations, including HIPAA and the principles and practices of information privacy laws, access, release of information and release control technologies.  
• Practiced in demonstrating the ability to relate to people effectively, sensitively, and respectfully from different cultural groups.  
• Ability to work well independently and collaboratively with teams. 
• Experience providing supervision and direction to staff.  
• Knowledge of principles and methods for practices of project planning, system analysis, monitoring, problem solving, implementation and evaluating, development and evaluation.  
• Understanding and knowledge of pertinent laws and regulations regarding mental health and social service programs and the ability to apply state, federal, and local regulations related to quality assurance and utilization review. 
• A thorough working knowledge of Medi-Cal regulations and requirements.  
• Proficiency in Microsoft Office programs, systems, and platforms. 
• Ability to learn and use required mobile devices and business-related applications. 
• Outstanding communication skills and high degree of emotional intelligence, cultural humility, with a proven track record to build and maintain effective relationships with a wide variety of internal and external contacts. 

Notice: This description is to be used as a guide only. It does not constitute a contract, commitment or promise of any kind. Abode Services reserves the right to change, add, delete, upgrade, or downgrade the position as dictated by business necessity at any time with or without notice. 

Notice: Abode Services is an Equal Opportunity Employer/Drug Free Workplace.