Quality Improvement Coordinator (2575)

Quality Improvement CoordinatorPOSITION OVERVIEW

Appeals Specialist gathers and prepares materials for formal appeals, conducts informal reviews, and assists with recoupment efforts when needed. Appeal Specialists communicates with customers to ensure full understanding of appeal requests. Appeal Specialists coordinates with Quality Coordinator II Supervisor and Customer Information and Resource Supervisor on the concerns of the customer’s appeal, reviews for errors, makes recommendations for system improvements. The Appeals Specialist compiles, reviews, and maintains case documentation to support the board appeals process.

Expected Positive Outcomes

• Compiles and prepares materials for customer appeal of termination/denial of services.
• Conducts informal appeal reviews.
• Determines if actions taken were within established rules and procedures.
• Performs fact finding tasks and prepares materials associated with the outcome of appeals hearing, and potential fraud and exception reports.
• Tracks and reports on all appeals and outcomes of appeals, and on all potential fraud and exception reports.
• Maintains the confidentiality of case records.
• Performs other duties as may be assigned

JOB FUNCTIONS

Benchmark Job

x

Remote Work Eligible

Essential Functions

Essential Function

Researches and compiles responses for various compliance reports

Develops working knowledge of applicable policies, procedures, and processes including local, state, federal and contractual requirements in order to proactively assess assigned organizational compliance

Analyzes repeated staff errors and coordinates actions to assist staff in developing methods to prevent recurrence of errors

Prepares and presents training materials to staff and coaches staff through awareness sessions and specific training to address monitoring findings

Prepares and presents related compliance reports to management identifying areas of noncompliance and maintains complete, organized and accessible compliance records

Maintains a master policy and procedures file in a shared drive database containing policy directives and Workforce Development letters

Conducts quality and compliance inspections of Child Care case files. Develops and utilizes appropriate tools and processes for monitoring consistency

Provides technical assistance to program and administrative staff to document and improve processes; creates and updates process maps and procedures

Additional Responsibilities

•Performs other duties as assigned

Required for All Jobs

• •
• Complies with all policies and standards

QualificationsPREFERRED/ REQUIRED QUALIFICATIONS

Education

Education Level

Education Details

Required/ Preferred

Bachelor's

Degree

from four-year college or university in field related to core duties and responsibilities and one year of experience,

Preferred

or

Associate's

Degree

and three years’ experience in field related to core duties and responsibilities

Required

Work Experience

Experience

Experience Details

Required/ Preferred

2-4

Minimum of two years of working knowledge of Child Care Services policies, procedures, and regulatory requirements.

Required

2-4

Established professional relationship with Board staff, with ability to collaborate effectively across departments.

Preferred

Knowledge, Skills and Abilities

KSAs

Proficiency

Intermediate/Advanced analytical skills

Proficient

Intermediate/Advanced organizational skills

Proficient

Excellent verbal and written communication skills

Proficient

• Ability to calculate figures and amounts
• Ability to work with others

Proficient

Ability to effectively present information and respond to