Quality and Compliance Manager
LOCATION: Milford, CT
At Boys & Girls Village, we understand that children and families are the cornerstones of our society. Since 1942, it has been our mission to preserve and strengthen family bonds. As a leader in services for troubled youth and their families, we continually strive to develop a seamless continuum of care. Boys & Girls Village offers an array of services for children and their families. These services range from highly structured sub-acute services on campus to intensive intervention and care in the home and the community. Our broad range of programs and services are designed to work collaboratively with families, state and local agencies, and other community providers.
PURPOSE/FUNCTION OF THE PROGRAM
The Quality function at BGV is integral to the agency successful implementation of its mission and vision. The overarching goals of the Quality/Compliance department are to ensure that services are quality driven, effective and adhere to various regulatory requirements. The Quality function is pervasive throughout the organization and the
department through its various tools including the PQI plan, program/agency benchmarks, contract deliverable's, data
management and audits serve to provide an agency wide structure and monitoring of the various components.
Under the direction of the Director of Compliance & Quality Assurance, the Manager identifies compliance issues, monitors, and performs ongoing audits to ensure compliance with program contracts, program policies/procedures as well as Federal and State standards, regulations and legislation. The plans of action, as determined in consult with the Director, will be implemented by the Manager including meetings with staff, training and re-auditing to ensure implementation. This position requires an ability to read, analyze and interpret/implement state and federal laws, rules and regulations within a healthcare setting. The Manager is also responsible to ensure successful licensing and QA functions are being met.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
1. Ensures compliance with all regulatory bodies including Medicaid, COA, DCF, DPH, CSSD, and others as may be required to provide agency services and ensure payment.
2. Reviews requests for information received by the Keeper of Records (QA Support Technician) to ensure compliance with HIPAA regulations.
3. Identifies changes to state and federal compliance requirements. Proactively recommends implementation plans to ensure adherence to requirements.
4. In collaboration with program management, performs and manages chart audits in electronic health record (Carelogic by Qualifacts) on a routine and rotating basis for compliance with program contracts, program policies/procedures, and payer requirements. Proactively apprises director and team members of recommendations to improve chart audit procedures and electronic medical record documentation.
4. Monitors electronic medical record documentation to ensure standards of payer medical necessity are met.
5. Tracks, inputs, creates, and presents written analyses of chart audits.
7. Responsible for developing and updating the agency program manuals to ensure compliance with state, federal, and other regulations.
8. Provides verbal and written communications related to assigned compliance projects, prepares project
summary reports, and proactively identifies and initiates process improvement recommendations.
9. Proactively identifies, monitors, and apprises agency leadership of compliance risk areas.
10. Assists in identifying and monitoring QA indicators in electronic health record and external systems/reports to ensure compliance with agency and/or contract. Presents findings to agency leadership, management, and program staff.
11. Takes full ownership of managing agency contract procedures, including BAAs.
12. Provides related in-services and trainings to staff, including monthly HIPAA pre-service training.
13. Manages program specific licensing/reaccreditation processes in collaboration with program leadership.
OTHER DUTIES AND RESPONSIBILITIES
1. Perform other duties as assigned by supervisor.
1. Minimum of a bachelor’s degree.
2. Experience with electronic medical records
3. Experience regularly interreacting and communicating with senior leadership staff (e.g., President/CEO;
Vice Presidents; CFO).
4. Experience in clinical compliance auditing and health care.
5. Strong organizational skills and attention to detail.
6. Excellent problem solving, written and verbal communication skills, as well as the ability to
apply concepts to practical situations.
7. Ability to work independently within a team environment (comprised of 2 data analysts, database technician,
keeper of the records) and manage multiple assignments.
8. Ability to read, analyze, interpret, and effectively communicate state and federal laws, rules and regulations
1. Demonstrated knowledge of Medicaid regulations.
2. Three to five years of experience interpreting statutes/regulations and/or work in Regulatory Compliance.
3. Proficiency in Microsoft Office-Word, Excel and PowerPoint.
1. The QA Support Technician (Keeper of the Records) reports to them
1. Standard office conditions and equipment use apply.
2. Extensive periods of sitting.
3. May be required to lift and carry binders from building to building.
WORKING CONDITIONS AND ENVIRONMENT
1. Will be required to travel to agency site in Bridgeport.
2. Must be able to work a flexible schedule.
COME JOIN OUR TEAM!
Boys & Girls Village takes pride in the supportive, team-oriented work environment we offer to current and prospective employees. We offer a comprehensive benefits package including medical, dental, life insurance, short and long-term disability, a retirement plan and generous vacation benefits. In addition, it is our goal to assure that the highest quality of care is provided to our clients by our competent, committed employees. To that end, we encourage professional development through our tuition reimbursement program and promote continued growth through various learning opportunities.
Boys & Girls Village is an Equal Opportunity Employer. We accept resumes on an ongoing basis. Due to the large volume of resumes that we receive, we kindly ask that you do not inquire via telephone about the status of your resume. You can be assured that if you do not hear from us, your resume will be held on file for future consideration.
Due to the Department of Children & Families regulations, we are prohibited from hiring anyone with a pending charges or convictions of assault or a violent crime; risk of injury to a minor; impairing the morals of a child; physical or sexual abuse, possession; use or sale of a controlled substance; similar crimes.
We are an Equal Opportunity Employer.