Quality Coordinator

QUALITY COORDINATOR

Distinguishing Features of the Class
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This is a professional management position responsible for the establishment and oversight in the Department of Health of all quality standards and compliance within the organization as well as agency compliance to County, State, and Federal practices, laws, rules, and regulations. The duties involve ensuring compliance with Private Insurances, Medicaid/Medicare rules and policies by providing staff training; auditing billing submissions and reports, and developing and implementing policies in order to make system improvements.

The work involves responsibility and accountability for assessment, policy development, employee health requirements and training, and adherence to standards required by regulations and guidelines set by agency policy, legal mandates, and professional standards of practice. The work is performed under the general direction of the Director of Public Health or his/her designee with leeway allowed for the exercise of independent judgment in carrying out the details of the work.

Supervision may be exercised over the work of subordinate professional and clerical staff and interns. The incumbent does related work as required.

Typical Work Activities
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• Oversees all aspects pertaining to Private Insurances, Medicare/Medicaid regulations, audit(s) all billing and medical records for proper coding, claim for payments, billing and payment of services rendered;
• Responsible for auditing all DOH billing activity for appropriateness with various Federal, State, and Local insurance regulations; including private insurances, Medicaid/Medicare.
• Ensures current credentialing of all DOH providers for billing purposes and ensures in-network contracts are updated periodically;
• Active member with oversight of the Corporate Compliance Committee and reports all findings of potential violations, investigations, and results of audits, complaints, violations etc., to the Committee;
• Ensures documentation of education on the compliance plan annually and for all new employees/agents within Community Services, Department of Health and other related County programs;
• Audits and completes Quality Improvement planning, execution, and leads corrective action planning with all DOH programs and ensures compliance of all programming within DOH with Federal, State, and Local statutes;
• Maintains documentation of any investigations, corrective action, occurrence screens and audits in regards to the compliance plan;
• Ensure reporting of meeting minutes, investigation results and discipline to the Board of Health and Human Services Committee of the Legislature;
• Oversees and coordinates the department’s mandated trainings programs, required individual or group per the outline of staff job descriptions, grant requirements or professional need;
• Assists in policy and procedure development, revision, and implementation in carrying out certain aspects of administrative policies, and in monitoring for regulatory changes for such policies;
• Reviews and updates all existing DOH policies, procedures and written plans for accurateness. Tracks changes per requirements as well as create new written policies, procedures and plans as needed or required by department program objectives;
• Drafts, reviews, and completes budgets and reconciles budgetary cost center(s) for various DOH programs;
• Ensures compliance as well as assist Division managers with all grant objectives in order to file grant claim for payments and maintain awareness of grant deadlines;
• May act as HIPAA consultant to advise staff and assure that policy and procedures are adhered to and will report breaches to Director of Public Health or their designee;
• Maintains awareness of shared community health documents such…