Position Title:

Quality Assurance & Compliance Auditor

Department

COMPLIANCE

Reports to:

Director

FLSA Status:

EXEMPT

General Purpose

This position is responsible for overseeing quality assurance & compliance audits for the clinical and risk management improvement of all PACS facilities.

Essential Duties

• Supervise the PACS Compliance team to identify, monitor, and remedy potential regulatory issues.
• Reports to the Director of QA on compliance issues identified, to report on special project updates, and all other duties and obligations on this job description.
• Recruit and train additional compliance team members with advice of Strategic Planning as company growth requires.
• Oversee Compliance Team and make assignments for performance audits, special projects, and quality improvement initiatives around clinical, therapy and reimbursement systems.
• Oversee the Medical Records Auditor and work with the Director and Legal Team to improve medical records keeping processes and chart defensibility best practices.
• Work with EHR Program Manager on joint initiatives.
• Set annual compliance team initiatives with Director of QA.
• Monitor utilization of waiver programs for compliance in documentation and defense (e.g. 1135 waiver program).
• Monitor SNF QRP for penalties and opportunities with QM reporting.
• Work with quality analytics contracted vendor partners to measure trends and idenfity opportunities for improved client performance (e.g. Point Right etc.)
• Work on special committees for improvement in VBP (hospital readmission performance), PDPM, and other special projects including triple check tools development.
• Track key PDPM metrics and case mix group performance, report opportunities and develop training for facility implementation to improve PDPM performance.
• Monitor all activity from ADRs and other payment denials to minimize recoupment and keep Director of QA abreast of issues.
• Work with PACS interdisciplinary clinical and reimbursement teams as well as client facility leadership to defend against CMS Probes including RAC audits and ADR requests.
• Monitor Pepper Reports and VBP Reports and communicate opportunities to Director of QA.
• Oversee and direct the Compliance Team to monitor client facility rehab services and monitor rehab metrics.
• Direct Compliance Team to consult/advise and make strategic therapy suggestions to help facility rehab departments achieve best performance.
• Monitor and oversee contract Vendor therapy services for performance and regulatory compliance.
• Chair special projects around therapy, clinical, and reimbursement systems and help create education materials to help client facilities achieve best performance and regulatory compliance.
• Maintain and update Best Practices and Rehabilitation Policy and Procedure Manual.
• Maintain and update Therapy Best Practice Manual for in-house and vendor programs.
• Manage regional compliance teams to support local therapy activities and monitor therapy metrics including CPM, Productivity, and PDPM performance opportunities.
• Assist in converting vendor therapy programs to in-house therapy programs.
• Manage and refine therapy software programs for best patient and metric outcomes (i.e. Casamba, Rehab Optima) to support compliance.
• Identify training opportunities around compliance, including clinical, rehab, reimbursement compliance.
• Build relationships with RDO?s and RDCS?s and facility leaders in order to communicate training needs and assist in improve compliance performance in clinical, rehab, and reimbursement systems.
• Assist with new Providence acquisitions to facilitate assimilation of therapy staff.
• Monitor survey tags, maintain deficiency log for all PACS clients, and keep a separate record of harm level tags and other substandard care tags and report all this to VP of Strategic Planning at least quarterly
• Take additional assignments and direction for work priority as directed by the Director of QA

Supervisory Requirements

None

Qualification

Education and/or Experience

Masters Degree or higher as a Therapy Professional and/or BS in Nursing, 10+ years? experience in therapy management and quality assurance expertise.

Language Skills

• Strong communication skills including outstanding interpersonal skills
• Excellent analytical and problem-solving ability

Mathematical Skills

• Critical thinking
• Problem solving
• Analytical thinking
• Quantitative reasoning

Reasoning Ability

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Strong relationship building skills
• Knowledge of leadership principles and information management
• Excellent time management, follow through and organizational skills.

Certificates, Licenses, Registrations

Registered Therapist or Registered Nurse in good standing in the state where candidate resides

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must occasionally lift and/or move up to 25 pounds. Prolonged use of a desktop or laptop computer. While performing the duties of this job, the employee is regularly required to sit, stand, walk and talk, read or hear. Frequent use of all office related equipment to include; copier/scanner/fax, telephone, and calculator.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually low to moderate.

Additional Information

Note: Nothing in this job specification restricts management?s right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons. The above statements are strictly intended to describe the general nature and level of the work being performed. They are not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in this position.

I have read and understand the duties of my position: