Adult Care Management Quality Assurance Assistant

Mission Statement: “To empower and inspire people of all communities to identify, pursue and sustain healthy, meaningful lives”.

MHAW strives to develop an authentic, diverse workforce that embraces, creates, respects and demonstrates diversity, equity, and inclusiveness in the work environment, towards one another and those we serve. We recognize that our agency is strongest when we all embrace the full spectrum of diversity and experience. We actively seek to employ a diverse workforce representative of the communities we serve.

MHAW is a pro-vaccination agency, and has required all staff to be fully vaccinated and encourages service recipients to be vaccinated against Covid-19.

Position: Adult Care Management Quality Assurance Assistant
Compensation: $50,000.00 per year
Location: Office-based positon, Ronkonkoma, NY
Hours: Full time, 37.5 hours per week (non-exempt)
Start Date: Immediately

Key responsibilities will include but are not limited to:

• Interfaces regularly with Care Managers, Care Management Leadership Team, Billing Revenue Management Supervisor and Database Administrator.
• Maintains working knowledge of DOH/Health Home Policies and Procedures and participates in Health Home facilitated meetings and webinars as requested.
• Demonstrates computer proficiency and good understanding of EHR – Cerner Millennium and Health Home IT platform – Foothold Care Management (FCM). Reviews and enters BSQ assessments in FCM.
• Utilizes PSYCKES (Psychiatric Services and Clinical Knowledge Enhancement System), a NYS web-based application, to review eligibility and identify qualifying factors that impact completion of monthly billing questionnaires.
• Runs PSYCKES report, using various criteria/filters and merges with CICBH Client Assignment Report to determine those on roster who may be eligible for HH Plus.
• Enters and utilizes billing authorizations with begin/end dates in EHR to track BSQ functional categories (i.e. homelessness, incarceration, inpatient hospitalization, SUD, etc.).
• Runs reports, utilizing EHR and HH platform, and distributes to Care Management leadership team to ensure that BSQ functional categories are addressed as required.
• Generates other reports as requested for purposes of Q&A, distribution, tracking and audits. Completes other data entry tasks as requested (in EHR and IT platforms).
• Performs audits to ensure that service delivery requirements are met for Health Home Plus program as well as those in other special populations (i.e. AOT, State Aid).
• Tracks and monitors start/end dates for Health Home Plus clients and communicates to Care Management leadership team.
• Has a keen eye for problem patterns, notes observations and communicates to Assistant Program Director and/or Program Director and Billing Revenue Management Supervisor in a timely fashion.
• Assists with quality improvement projects and contributes to the continuous improvement process, development of new procedures, workflows and forms.
• Ensures that all client records are updated, accurate and complete and assists in audit processes (internal and HH) when requested.
• Runs, analyzes and distributes reports from FCM to support timely completion of HH Comprehensive Assessments, HH Care Plans, Consents, etc. via the Leadership Monthly Tracking Report (LMTR).
• Generate and distribute Low Acuity Report and Exceptions Report according to schedule.
• Monitor client Medicaid inactivity and track those with R69/H1/H9 status.
• Utilize Unbilled Claims Report to complete monthly review and work with leadership team to address necessary corrections within established time frames.

Qualifications:

The successful candidate should possess or be quickly able to acquire the following skills and abilities:

• Bachelor’s Degree in Business, Health Administration or Human Services field is preferred.
• Care Management experience preferred.
• Detail-oriented, reliable self-starter with the ability to work both independently and as part of a team.
• High degree of proficiency in navigating multiple computer platforms.
• Candidate must be fully COVID-19 vaccinated.

Adult Care Management Quality Assurance Assistant

Mission Statement: “To empower and inspire people of all communities to identify, pursue and sustain healthy, meaningful lives”.

MHAW strives to develop an authentic, diverse workforce that embraces, creates, respects and demonstrates diversity, equity, and inclusiveness in the work environment, towards one another and those we serve. We recognize that our agency is strongest when we all embrace the full spectrum of diversity and experience. We actively seek to employ a diverse workforce representative of the communities we serve.

MHAW is a pro-vaccination agency, and has required all staff to be fully vaccinated and encourages service recipients to be vaccinated against Covid-19.

Position: Adult Care Management Quality Assurance Assistant
Compensation: $50,000.00 per year
Location: Office-based positon, Ronkonkoma, NY
Hours: Full time, 37.5 hours per week (non-exempt)
Start Date: Immediately

Key responsibilities will include but are not limited to:

• Interfaces regularly with Care Managers, Care Management Leadership Team, Billing Revenue Management Supervisor and Database Administrator.
• Maintains working knowledge of DOH/Health Home Policies and Procedures and participates in Health Home facilitated meetings and webinars as requested.
• Demonstrates computer proficiency and good understanding of EHR – Cerner Millennium and Health Home IT platform – Foothold Care Management (FCM). Reviews and enters BSQ assessments in FCM.
• Utilizes PSYCKES (Psychiatric Services and Clinical Knowledge Enhancement System), a NYS web-based application, to review eligibility and identify qualifying factors that impact completion of monthly billing questionnaires.
• Runs PSYCKES report, using various criteria/filters and merges with CICBH Client Assignment Report to determine those on roster who may be eligible for HH Plus.
• Enters and utilizes billing authorizations with begin/end dates in EHR to track BSQ functional categories (i.e. homelessness, incarceration, inpatient hospitalization, SUD, etc.).
• Runs reports, utilizing EHR and HH platform, and distributes to Care Management leadership team to ensure that BSQ functional categories are addressed as required.
• Generates other reports as requested for purposes of Q&A, distribution, tracking and audits. Completes other data entry tasks as requested (in EHR and IT platforms).
• Performs audits to ensure that service delivery requirements are met for Health Home Plus program as well as those in other special populations (i.e. AOT, State Aid).
• Tracks and monitors start/end dates for Health Home Plus clients and communicates to Care Management leadership team.
• Has a keen eye for problem patterns, notes observations and communicates to Assistant Program Director and/or Program Director and Billing Revenue Management Supervisor in a timely fashion.
• Assists with quality improvement projects and contributes to the continuous improvement process, development of new procedures, workflows and forms.
• Ensures that all client records are updated, accurate and complete and assists in audit processes (internal and HH) when requested.
• Runs, analyzes and distributes reports from FCM to support timely completion of HH Comprehensive Assessments, HH Care Plans, Consents, etc. via the Leadership Monthly Tracking Report (LMTR).
• Generate and distribute Low Acuity Report and Exceptions Report according to schedule.
• Monitor client Medicaid inactivity and track those with R69/H1/H9 status.
• Utilize Unbilled Claims Report to complete monthly review and work with leadership team to address necessary corrections within established time frames.

Qualifications:

The successful candidate should possess or be quickly able to acquire the following skills and abilities:

• Bachelor’s Degree in Business, Health Administration or Human Services field is preferred.
• Care Management experience preferred.
• Detail-oriented, reliable self-starter with the ability to work both independently and as part of a team.
• High degree of proficiency in navigating multiple computer platforms.
• Candidate must be fully COVID-19 vaccinated.

Send a resume and cover letter expressing your interest in this position to:

Kathy Elfers
HR Director
Fax: 631-676-6934
Kelfers@mhaw.org

Self-Insurance- What are the REAL risks?

With the cost of health insurance continuing to skyrocket, non-profit employers are searching for answers when it comes to providing benefits to their employees. More organizations than ever before are turning to self-insurance in attempt to gain more transparency, drive down costs, and offer more attractive benefits to their employees. For non-profits with over 100 employees in NY, and even smaller  in other states this may be the solution.  So why is there still some resistance?  Risk is always a concern especially for non-profit organizations.  Factoring the high cost of healthcare especially in metropolitan markets, self-insurance can be scary words.  However, this begs the question, are they really getting a true depiction of what their risks are?  Probably not.  We find that most organizations do not have good understanding of what self-funding means and fear of the unknown always creates anxiety.  In addition, Boards may be resistant to anything that smells like fiduciary liability.   Insurance carriers that market fully insured plans and large brokers have profitable stakes in those plans so there may not be enough motivation to educate non-profits of what risks really exist.  Of course, self-funding is not for every organization, but in an environment where benefits are paramount to recruiting and retention, employers should be exploring all options to reduce cost and increase benefits including alternative funding options like self-insurance.

The real question is, what’s riskier, a fully insured contract through an insurance carrier which almost certainly guarantees renewal increases year over year, or a long term self-funded strategy focused on reducing healthcare costs?   With fully insured plans you are offered rates upon renewal based on your previous claims experience.  Those rates are locked in for a year in most cases, however if claims improve you cannot recoup those funds.  When employers pay their own claims, they save hard dollars in real time if claims improve.  This motivates them to take cost reduction, and wellness initiatives.  Self -funded plans put the employer in control of their healthcare and pharmacy spend allowing them to make financial decisions based on more accurate data that comes in real time which does not exist with fully insured plans.  Most often we hear that non-profit employers are concerned a major claim could wipe them out.  However, a properly designed self- funded strategy with appropriate stoploss contracts can eliminate those financial risks making it easier to forecast costs into the future.   Recently direct hospital relationships with large healthcare systems like Northwell Health have created opportunities for employers to offer incentives to employees who access care within the system.  With deeper discounts embedded within the direct relationships, employers can realize significant cost savings within their self-funded plans. 

Non-Profit employers should not dispel self-funded plans without a full exploration of their benefits and risks.  Brokers who work with experienced Third-Party Administrators can easily provide proposals which will clearly outline what their maximum liability would be.  Employers that qualify should consider getting customized proposals to help them better understand how self-funding works before determining whether it is too risky for them.  With the rise in healthcare costs not slowing down, what do they have to lose?