Quality Assurance Specialist

JOB SUMMARY

The Compliance Specialist (CS) aids in development, administration, and maintenance of systems to ensure compliance with County and State Medi-Cal (MC) requirements and Medicare requirements, in addition to ensuring accurate data collection and verification using InSyst and / or other information databases.

The CS also performs other duties, as assigned by the Program Manager.

RESPONSIBILITIES

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

• Maintains systems for accurate service data entry and tracking for program services.
• Develops and maintains effective liaison with County behavioral health department.
• Reviews and tracks all service data reports to ensure accurate data entry and billing processes.
• Completes regular quality improvement reviews of client charts.
• Facilitates Peer Review process for treatment programs.
• Conducts HIPAA Site Reviews for program.
• Monitors and supports the completion of chart archiving for programs.
• Supports program preparation for all site reviews and chart audits and participates actively during reviews / audits.
• Organizes documentation requirements for audit appeals or plans of correction.
• Provides training to staff relevant to all needed areas of chart documentation and contract compliance.
• Represent Mental Health Division at community and other agency QI meetings and functions.
• Maintains professional currency by reading appropriate publications, attending seminars, and other training, as necessary.
• Consults with supervisor and Department and Division staff, on a regular basis to ensure program development.
• Excellent written and oral communication skills.
• Management ability to plan, prioritize, control, and evaluate at a level sufficient to ensure the efficiency, effectiveness

and success of the program.

• Effective communications and interpersonal relationships with co-workers and staff.
• Resourcefulness, initiative, and the ability to work with minimal direction and supervision.
• Speak well and in an organized manner when making public presentations.
• Comply with all MHS and program rules, policies and procedures including HIPAA standards.

QUALIFICATIONS

• Bachelor of Arts degree in a social services or related field preferred. Master’s degree in human services field highly valued.
• One-year experience working with participant charts.
• Two years of administrative experience.
• Proficient user of Microsoft Office Suite and EHR software.
• Ability to problem solve and react appropriately to emergency situations.
• Ability to work independently and effectively collaborate with a team.

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with qualified disabilities to perform the essential functions.

Seeing

Hearing

Speaking

Stooping / Bending

Working in cramped spaces

Moving around office

Moving between offices / clients

Driving

Climbing

Lifting / carrying heavy items

Pushing / pulling / dragging items

Standing for long periods

Working outside / underground

Using hands / fingers

Sitting for long periods of time