Director of Quality Improvement and Compliance

About the Collaborative for Children and Families (CCF) The Collaborative for Children and Families, Inc. (CCF) is a 501c3 Non-Profit Membership Coalition comprised of over 20 Community Based Organizations (CBOs) whose primary mission is to serve children and families across the downstate region of NY. CCF is designated as a Lead Health Home Serving Children (HHSC) that includes a provider network of over 40 Care Management Agencies (CMAs) throughout the downstate region. CCF offers comprehensive health and human services to children and families in a more coordinated manner than could be achieved individually and seek partnerships with other components of the health and human services systems to integrate care for those in greatest need. Collectively, CCF serves nearly all the youth in foster care in the greater New York City area and over 60 percent of the children and families receiving preventive care in NYC Child Welfare System. On any given day, our providers serve more than 30,000 children, providing foster care, preventive care, early childhood education, schools and educational programs, behavioral health, school-based mental health, case management, summer camps, after-school programs, and residential treatment. About the Position CCF is seeking a dedicated Director of Quality and Compliance to oversee the Quality Improvement (QI) Department. Working under the direction of the Chief Operating Officer, the Director of Quality and Compliance is responsible for ensuring proper program administration set forth by the requirements of government contracts including proper adherence to policy and protocol, billing, monitoring, and reporting. The Director of Quality and Compliance is the primary liaison between CCF and the CMA network to ensure compliance with all regulations, funding sources and stakeholders. The Director manages a team of QI staff who support the organization in maintaining compliance as well as evaluating processes for continuous quality improvement (CQI). The Director of Quality and Compliance will serve as the designated Compliance Officer for the organization, acting as the primary liaison between CCF and external oversite entities including but not limited to the State Department of Health (DOH) and Office of Medicaid Inspector General (OMIG) to ensure compliance with Center for Medicaid Services (CMS) standards. Responsibilities · Work under the direction of the Chief Operating Officer to ensure compliance and adherence to state and local policies are monitored in accordance with guidance and regulations. · Ensure that the Health Home CMA network is monitoring progress towards achieving performance measures for children such as NCQA, NYS HEDIS and QUARR measures that monitor quality of care. · Ensures the Health Home CMA network is adhering to NYS DOH Health Home policies and standards by conducting routine audits, investigations, and data analysis. · Designated Compliance Officer for any OMIG self-disclosures, investigations or reporting of Fraud, Waste and Abuse (FWA) as well as any HIPAA risk assessments. · Implement CQI methodologies thought the organization and network. · Execute and maintain compliance with CCF’s Compliance Plan · Prepares regular status reports on the performance of the programs and on any issues that may require additional oversite or attention. · Serves as the lead contact for all external oversite entities for audits and responsible for responding to and implementing any changes needed for corrective action plans/ performance improvement plans. · Undertake special projects and prepare special reports as assigned by Executive Management · Provide back-up assistance to other contract staff. · Oversees the development of compliance policies, procedures, and programs; provides continuing guidance on compliance matters and compliance standards to the CCF Health Home CMA network; · Coordinates and collaborates with other department heads with creating and implementing corporate policies · Ensures compliance policies and programs are comprehensive, current and reflect Professional’s business practices. · Develops measurement tools to measure quality performance, conducts internal compliance chart reviews; Investigating complaints: When a compliance issue arises, Director investigates the matter to identify the root cause and recommend corrective action, and develops corrective action plans. · Maintains professional and technical knowledge of health care internal audit process. · Review and approve all marketing materials and other business communications as necessary to ensure compliance with applicable regulations. · Investigate complaints and coordinate actions plans with other departments; compiles reports of calls received, investigations conducted, findings and recommendations developed, action plans established, and progress noted. Requirements · Master’s degree with a minimum of 5 years of experience in Public Policy/Administration, Sociology, Management, Statistics, Data Science, Economics, or related field. · A minimum of 2 years of direct supervision and management of individuals and teams · Certified Healthcare Compliance Professional preferred · Certified Microsoft Power BI (PBI) preferred · Knowledge of Office of Medicaid Inspector General (OMIG) rules and regulations · Experience managing large data set with Excel, creating pivot tables, using sorting/filtering criteria and creating reports for presentation to executive leadership. · Comfortable with Billing Data Concepts (Accounts Receivable, Claims, Remittance, Denials, etc.) as it relates to Medicaid billing. · Knowledge of the NYS Medicaid eligibility requirements and benefits · Knowledge with government contract billing and reimbursement · Ability to manage overview of billing workflows. · Comfortable in a wide range of technology and systems Additional Qualifications · Knowledge and understanding of Medicaid Billing preferred. · Preferred understanding of NYS Health Home service concepts being provided in relationship to billing requirements. · Excellent time management and documentation skills · General math skills with particular attention to detail · Microsoft proficiency: Word, Excel, PowerPoint · Preferred knowledge of developing queries or dashboards in an interactive database such as Microsoft Power BI, Tableau, etc. · Able to work well with colleagues in order to identify, resolve and share information regarding the billing process. · Able to handle expected volume of work/quickly resolve problems and escalate appropriate problems to management. · Adapts well to change. · Excellent communicator with good interpersonal skills · Ability and willingness to attend workshops/trainings/webinars upon request. · Accepts responsibility for accuracy of data. · Ability to work independently with little supervision. · Applies common sense understanding to carry out detailed but uninvolved written or oral instructions. WORKING CONDITIONS: · 35 hour/week, flexible in accordance with program needs · Ability to travel as needed. · Some nights and weekends may be required. Job Type: Full-time Pay: $85,000.00 - $95,000.00 per year Work Location: Remote Apply tot his job