Consultant- Clinical Quality Assurance Analyst - NYSTEC

About Us:

NYSTEC is a nonprofit technology consulting company, advising agencies, organizations, institutions, and businesses since 1996. We’re independent and vendor-neutral, so we have our clients’ best interests at heart. At NYSTEC, we know that we succeed when individuals and teams flourish personally and professionally, so our benefits and perks support that mindset.

About the Role:

As a clinical quality assurance analyst in the quality systems transformation practice, you will collaborate with team members to conceptualize, deliver, and support our clients through today’s ever-changing healthcare landscape. NYSTEC is considered a trusted program advisor, providing subject matter expertise and connecting the dots for our clients. Over the last five years, NYSTEC has consulted on some of the largest Medicaid initiatives and served in various roles across a multitude of New York State healthcare technology systems.

Serving as a clinical quality assurance analyst, your day-to-day role as a consultant will be to provide analysis expertise to evaluate the performance of the 1915(c) Children’s Waiver across New York State. This role will be based in our Albany office. This role may include travel across New York State including New York City.

Key Responsibilities

• Evaluate child/youth cases for compliance to applicable regulations.
  • Clearly communicate evaluation requirements and follow up.
  • Evaluate documentation against applicable State/Federal regulations.
  • Collect data and documentation to support compliance findings.
  • Utilize technology to convert hard copy documentation to electronic and submit via secure file transfer.
  • Record, summarize, and communicate compliance findings for the Children’s Transformation Program.
  • Assist in determining trends in non-compliance.
  • Make appropriate and timely recommendations to project management.
  • Travel to provider sites to perform case reviews.
• Assist with the ongoing operationalization of the project’s processes and procedures.
• Assist with all internal and external reporting.
• Build and maintain relationships with stakeholders to provide a high level of customer service.

About you:

Required Qualifications

• A minimum of 2 years of experience as a Licensed Mental Health Counselor (LMHC), Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Registered Nurse (RN), Care Manager, Children’s Medicaid Provider, or Healthcare Compliance Analyst, in a role working with critical care providers, public health providers, or providers that care for children, older adults, persons with traumatic brain injury, persons with emotional disturbances, or persons with developmental disabilities.
• Experience with Medicaid fee-for-service and/or Managed Care billing.
• Proficiency in MS Excel, MS Word, MS Outlook, MS Visio, MS PowerPoint and MS SharePoint.

Preferred/Desired Qualifications

• Extensive knowledge of, and experience with Home and Community Based Services Waiver Programs, including the 1915(c) NYS Children's Waiver, either as a provider or compliance officer.
• Experience working with eMedNY, CANS-NY, UAS-NY, Medicaid Health Homes, Medicaid Managed Care Organizations (MMCOs), or other related programs/systems.
• Experience with NYS Medicaid billing, including the use of various Electronic Health Records (EHR) systems.
• Experience working with Office of Mental Health (OMH), Office for People with Developmental Disabilities (OPWDD), or Office of Children and Families (OCFS).
• Experience with compliance audits or chart reviews.
• Ability to work with and relate to staff and demonstrate active listening skills.
• Have a process oriented and results-driven work strategy.
• Ability to foster teamwork with all levels of management and staff.
• Ability to work well independently and within a team.
• Exceptional customer service relationship techniques, including superior verbal and written communication skills.
• Excellent accuracy and attention to detail.
• Experience in meeting deadlines and adhering to strict standards of performance

Education and Experience

• A minimum of a bachelor’s degree in public health, healthcare management, psychology, human services, or related field, with at least two years of related experience, as defined above, is preferred. An equivalent combination of advanced education, training, and experience will be considered.

The pay range for this position is $60,406.00 to $82,959.80 per year.

It is NYSTEC's policy to provide equal employment opportunity (EEO) to all individuals, regardless of actual or perceived race, color, creed, religion, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), age, national origin, ancestry, citizenship status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, military service and veteran status, sexual orientation, marital status, or any other characteristic protected by local, state, or federal laws and ordinances. NYSTEC is strongly committed to this policy and believes in the concept and spirit of the law.

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please contact recruitment@nystec.com if you require a reasonable accommodation to apply for or to perform this job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Applicants must be authorized to work in the United States without the need for visa sponsorship now or in the future.

Learn more about NYSTEC by visiting www.nystec.com.