Quality Coordinator

Distinguishing Features of the Class:

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:

• 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 departments 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 as CHIP CHA and CSP;
• Identifies and facilitates opportunities for public health to contribute to collective efforts;
• Assists divisions in identifying service gaps in aligning current and new programs/activities with community health efforts;

Full Performance Knowledges Skills Abilities and Personal Characteristics:

Thorough knowledge of County State and Federal practices laws rules and terminology regarding quality assurance and agency compliance; Thorough knowledge of modern auditing and accounting methods; Thorough knowledge of monitoring and analyzing financial and billing processes necessary to assist with reimbursement; Thorough knowledge of public health practices and principles including population-based health improvement; Thorough knowledge of public health accreditation process; Good knowledge of quality improvement science and application; Ability to create policy and procedures; Ability to communicate effectively orally and in writing; Ability to plan and administer staff education development; Ability to use and request technology systems for accurate efficient and secure data management record keeping and communication for employee health and educational needs; Ability to provide trainings and professional presentations; Ability to describe and apply skills of core competencies within the context of the essential public health services; Ability to establish and maintain cooperative working relationships; Sensitivity to individual client needs with the ability to approach situations and establish policies that take into account diversities and cultural differences; Flexibility; Sound judgment.

Minimum Qualifications:

Graduation from high school or possession of an equivalency diploma plus EITHER:

(a) Graduation from a regionally accredited or New York State registered college or university with a Bachelors degree. OR

(b) Graduation from a regionally accredited or New York State registered college or university with an Associates degree plus two (2) years of full-time experience either supervising or participating in the review submission and auditing of Private Insurances Medicaid/Medicare reimbursement forms insurance or medical claims.

NOTE: Your degree must have been awarded by a college or university accredited by a regional national or specialized agency recognized as an accrediting agency by the U.S. Department of Education/U.S. Secretary of Education. If your degree was awarded by an educational institution outside the United States and its territories you must provide independent verification of equivalency. A list of acceptable companies who provide this service can be found on the Internet at

Civil Service Jurisdictional Classification: Exempt

This description is a representative summary of the major responsibilities and accountabilities performed by incumbents in this job title. The incumbent may not perform all of the specified duties nor are the listed examples exhaustive. Incumbents may be requested to perform related tasks other than those stated herein.

To apply please submit your civil service application resume cover letter references and a copy of your attorneys license to Allegany County Human Resources & Civil Service 7 Court Street Room 216 Belmont NY 14813. Please visit Allegany County Human Resources
for the complete job description and the civil service application.