Grace Morales-Reyes

Receptionist and Insurance verification duties and responsibilities include greeting patients, scheduling appointments, making copies, answering phones. Verification specialist responsibilities include ensuring that patient health care benefits cover the required procedures. Contacting various insurance companies to verify coverage levels and explaining insurance coverage and benefits for the procedures that patient will be having done. Also knowing CPT Codes for procedures while using different websites for various insurance companies. Also informing patients of their monetary responsibility.

The Quality Assurance Auditor ensures the delivery of high-quality personal assistance services by monitoring, evaluating, and improving care processes and compliance with established standards and regulations.

Conducting Quality Audits:Plan, schedule, and execute comprehensive audits of personal assistance services, including in-home visits and documentation reviews.
Evaluate adherence to established policies, procedures, regulations, and personalized care plans.
Assess client safety measures, infection control protocols, and emergency preparedness plans.

Compliance and Regulation:Verify compliance with all relevant regulatory standards, including state regulations, Medicare and Medicaid requirements, and HIPAA regulations.
Stay updated on industry trends and changes in regulations to ensure ongoing compliance.

Documentation and Reporting:Meticulously document all audit findings, including non-compliance issues and areas for improvement.
Prepare detailed reports for management, outlining audit results, trends, and recommendations.
Analyze data to identify quality issues, trends, and opportunities for improvement.

Continuous Quality Improvement:Collaborate with various departments, including caregivers and service coordinators, to address identified issues and implement corrective and preventive actions.
Monitor the effectiveness of implemented solutions and conduct follow-up audits as needed.
Participate in the development and update of quality control policies, procedures, and training materials.
Contribute to the agency's quality assurance and performance improvement (QAPI) initiatives.

Communication and Collaboration:Communicate effectively with staff, management, and potentially clients and their families regarding quality standards and audit findings.
Provide feedback and guidance to caregivers, identifying training needs and supporting their professional development.
Foster a culture of quality and continuous improvement throughout the organization.