Candace A. Syres, MPH

Experience

• 

  DBHIDS/Office of Addiction Services

  Aug 2015 - now

  Compliance and Quality Assurance Manager

  Develop and implement best practice processes for Billing, Compliance, Quality Assurance, Utilization Management and Risk Management for a BH-MCO: Behavioral Health Special Initiative (BHSI). Compliance: • Evaluate data analytics to identify potential unit liabilities and department-wide risks. • Orient and provide ongoing training to ensure staff knowledge of HIPAA rules, guidelines and compliance. • Create, revise and amend unit specific daily operating policies and procedures.• Investigate allegations of compliance infractions- present written report with recommendations of corrective actions to Corporate Compliance Officer• Manage all internal and external Quality of care and Financial audits. Quality Assurance:• Create processes and systems to address work procedure inefficiencies to manage shifts in work flow and performance management. • Manage internal and external complaints and grievances. • Develop performance improvement measures in conjunction with care coordination and utilization management. • Develop risk management, utilization management and billing core competencies. • Manage the receipt, documentation and investigation of all Significant Incidents. Show less