Quality Assurance Assistant at Advanced Behavioral Health – Middletown, Connecticut

POSITION SUMMARY:

The Quality Assurance Assistant is responsible for assisting in the day-to-day functioning of the Mental Health Waiver program in support of the Community Support Clinicians and the managerial staff by completing the payroll and reports for the self-directed employees, processing provider claims and the resulting check runs, assisting in maintaining the integrity of the eligibility/authorization database, completing and compiling satisfaction surveys. This position will represent ABH and its services in a positive and professional manner and adhere to ABH’s best practices, guidelines, policies and procedures as established, promoting ABH as a leader in behavioral healthcare in all interactions and work.

DUTIES AND RESPONSIBILITIES:

• Interacts in a professional and respectful manner with providers and office staff to answer routine inquiries related to the MHW eligibility, authorization and claims process;
• Completes the weekly payroll and associated reports for the Self-directed Recovery Assistants as needed;
• Adds new provider claims and uploads and downloads claims files as required;
• Coordinates with DSS, DHMAS, Gainwell Technologies, MFP and Sandata staff, and maintains a comprehensive knowledge of Mental Health Waiver services with regard to benefits, eligibility, network and referral options, and an understanding of all associated forms;
• Completes both the Client and the Provider satisfaction survey process by making calls, sending out mailings and tracking the results;
• Creates new client records by adding eligibility and disposition screens and client demographic information, adds authorizations, updates the various data bases as required.
• Performs the Project Notify/Connie process;
• Provides assistance to the CSCs in creating/updating recovery plans, and acts as a liaison between Waiver staff, Gainwell, Sandata and the Providers when there are authorization or payment issues;
• Provides assistance to the Provider Relations/Credentialing staff as necessary;
• Manages the toll free line, faxes, and requests for information by tracking calls and referrals and forwarding them to the correct responsible person;
• Assists with the monthly Eligibility verification, the Provider/Client Surveys and the Monthly notes process;
• Completes monthly mailings to Client and Providers;
• Observes policies and procedures related to confidentiality of medical records, release of information and retention of records;
• Monitors, identifies and reports problems of potential unethical conduct, fraud and/or abuse to QA Supervisor;
• Employs interpersonal expertise to provide good working relationships with members, providers, facilities and other ABH personnel;
• Maintains confidentiality of all client protected health information and adheres to all HIPAA related policies and procedures;
• Demonstrates ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds;
• Performs other tasks/responsibilities as required/assigned to support the business operations.

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Associate degree required or equivalent combination of education, experience and training that provides the required knowledge skills and abilities;
• 1-3 years of demonstrated work experience in a quality or financial related position.
• Payroll experience is preferred.

KNOWLEDGE/SKILLS/ABILITIES:

• Willingness to develop an in-depth knowledge of the WISE online system, other programs created by ABH and several State of CT online systems used to verify and coordinate services;
• Must be flexible in order to respond quickly and positively to shifting demands;
• Strong attention to detail; ability to work on multiple tasks and meet deadlines;
• Excellent PC skills with demonstrated experience using Microsoft Office Package (MS Word, Excel and Outlook);
• Expertise in or a willingness to learn the Payroll process.
• Strong written and verbal communication skills required;
• Excellent communication skills needed, and the ability to prioritize the needs of staff and providers.