Quality Control Specialist

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Full Time Niles, IL, US

2 days ago Requisition

Salary Range: $22.00 To $25.00 Hourly

About Company:

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The Quality Control Coordinator is responsible for monitoring and improving operational quality across all branch locations. This position serves as an independent oversight function, ensuring compliance with company standards, operational consistency, service excellence, documentation accuracy, utilization management, billing readiness, and performance accountability.

The Quality Control Coordinator conducts audits, analyzes operational data, identifies risks and performance gaps, develops corrective action plans, and provides leadership with actionable insights to drive continuous improvement. This role also oversees designated operational sub-departments to ensure processes are followed, expectations are met, and accountability measures are maintained.

Scope:
Quality Assurance, Utilization Oversight, Service Continuity, Branch Support, Operational Performance, and Sub-Department Oversight

Minimum Qualifications:

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field, or equivalent experience..
• 3+ years of experience in quality assurance, compliance, auditing, or healthcare operations.
• Experience conducting audits, reviewing documentation, and implementing corrective actions.
• Strong analytical, organizational, and problem-solving skills.
• Proficiency in Microsoft Office, especially Excel.

Preferred Qualifications:

• Experience in home care, home health, or healthcare services.
• Knowledge of utilization management, compliance, and billing processes.
• Experience with reporting, KPIs, and performance dashboards.
• Strong analytical and problem-solving skills with a proactive approach to quality improvement.
• Effective communication skills to liaise with cross-functional teams and external auditors.

Responsibilities:

• Quality Assurance & Internal Audits
  • Conduct scheduled and unscheduled audits of branch operations, client records, and supporting documentation.
  • Review client files, caregiver documentation, schedules, assessments, service notes, and operational records for accuracy, completeness, and compliance.
  • Identify operational risks, process deficiencies, documentation gaps, and quality concerns.
  • Develop, monitor, and track corrective and preventive action plans (CAPAs).
  • Verify completion of corrective actions and ensure sustained compliance improvements.
  • Provide audit findings, recommendations, and follow-up reports to leadership.
• Utilization Management & Schedule Oversight
  • Monitor missed visits and service interruptions to ensure timely completion of make-up hours when applicable.
  • Review schedules to ensure client-authorized hours are accurately reflected and utilized appropriately.
  • Verify timely system updates for authorization increases, decreases, or other service changes.
  • Monitor utilization reports to identify underutilized, overutilized, or unutilized service hours.
  • Ensure appropriate modification reasons and documentation are maintained for scheduling changes.
  • Collaborate with branch teams to improve service utilization and reduce service gaps.
• Billing Readiness & Revenue Integrity
  • Partner with billing and operational teams to identify and resolve discrepancies before billing submission.
  • Review authorization, utilization, and service reports to identify potential billing issues, shortages, or overages.
  • Verify services rendered align with authorized hours and supporting documentation.
  • Communicate identified concerns to branch leadership and facilitate timely corrections.
  • Support revenue integrity initiatives by ensuring documentation and services meet billing requirements.
• Service Continuity & Client Retention Oversight
  • Review and investigate client service interruptions, cancellations, and terminations.
  • Identify trends and root causes contributing to service disruptions.
  • Support branches in implementing corrective actions to reduce preventable client attrition.
  • Monitor clients placed on hold to ensure proper documentation and system updates are completed.
  • Verify appropriate transitions and follow-up procedures are completed for disenrolled clients.
  • Promote continuity of care and positive client outcomes through proactive monitoring.
• Client Assignment, Satisfaction & Performance Monitoring
  • Monitor…