GENERAL JOB DESCRIPTION
Perform duties within the Compliance Department to help ensure Agency compliance with program and regulatory guidelines.
SPECIFIC DUTIES & RESPONSIBILITIES
- Assist the CHRCO, Compliance Coordinator and other staff involved in Agency quality assurance activities.
- Perform a review of HCBS/CORE data and billing to ensure compliance with regulatory guidelines as needed.
- Perform a review of Health Home data to ensure compliance with regulatory guidelines including monthly, quarterly, bi-annual and annual audits or quality checks as needed.
- Assist with performing and documenting investigations involving Taking Control DCWs/PAs and consumers/Veterans when requested.
- Function as a member of the internal audit team.
- Fulfill and document medical records requests according to the Agency’s process as needed.
- Review Medicaid Transportation activity and billing to ensure compliance with process and regulations as needed.
- Assist with Agency billing quality assurance activity and with recovery efforts as needed.
- Assist with data entry for PAs/DCWs and consumers/Veterans in appropriate databases as required.
- Perform quality assurance tasks for Veteran Directed Care including the completion of surveys and monthly reviews of records as needed.
- Review new PA/DCW documentation to ensure it meets regulatory guidelines.
- Assist with performing and documenting investigations involving Taking Control PAs/DCWs and consumers/Veterans when requested.
- Participate in the performance of periodic reviews of database information to ensure accuracy and continuity across systems as needed.
- Conduct unscheduled visits to consumer/Veteran homes to monitor quality of care, consumer satisfaction, and program compliance as needed.
PPL Duties:
- Review PPL EVV noncompliance reports and perform follow up activities with consumer and PAs to develop the plan for EVV compliance.
- Monitor the EVV plan for one month to ensure compliance.
- Create and provide a monthly report on non-compliance for review by the Compliance Coordinator.
- Assist the CC with follow up on reports of Fraud, Waste or Abuse involving PPL consumers or PAs.
- Follow up with the consumer on the hours non-compliance and develop a plan for staying within the authorized hours.
- Assist with other special report projects for PPL as needed.
General Duties:
- Accurately document services and activity in WNYIL’s electronic consumer record and other applicable databases within two (2) business days of the date of service.
- Attend Agency’s in-service training and staff meetings as well as any other Agency-related activities as instructed.
- Participate in maintaining a neat, clean, and safe work environment.
- Perform other job-related duties as assigned by the supervisor.
EDUCATION & TRAINING
High School diploma or equivalent
OR
Associate degree in Human Services or related field
- Professional and life-experience may be considered in lieu of, in full or part of academic credentials.
KNOWLEDGE & EXPERIENCE (if required)
High School diploma or equivalent requires three (3) years of experience in the field of human services.
Possess prior knowledge, or the ability to learn OMIG/OIG/HHS/CMS/DOH regulations.
SKILLS & ABILITIES
- Must have reliable transportation in order to work independently throughout all counties where WNYIL operates.
- Must have an intermediate level of knowledge of computers, including the use of Excel spreadsheets, databases, word processing and networks.
- Perform in a professional, conscientious, and efficient manner for the purpose of ensuring a better quality of life for people with disabilities.
WORKING CONDITIONS
WORK ENVIRONMENT
Office/Community
PHYSICAL DEMANDS OF THE JOB
Sitting for extended periods of time.
Occasional lifting of not more than 15 pounds.
HOURS / SHIFTS
37.5 – 40 hours per week. M – F 8:30 am – 5:00 pm.
Overtime is rarely required.
CLASSIFICATION
Full-time, salary, non-exempt, support staff.
Salary:$45,000-$48,000
BENEFITS
Agency provided group health insurance.
Vision, dental, life, supplemental insurances available.
PTO and paid holiday package.
403(b) retirement with Agency match.
Employee Assistance Program
OTHER
Western New York Independent Living, Inc. values our employee safety and follows all recommended NYS required Infectious Disease Prevention Protocols.
Western New York Independent Living, Inc. is an Equal Opportunity Employer.
Reasonable accommodations will be made for people with disabilities.
Western New York Independent Living, Inc., is a scent-free agency.
Pay: $45,000.00 - $48,000.00 per year
Benefits:
- 403(b)
- 403(b) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
