Quality Assurance Specialist

　　Summary

　　Title: Quality Assurance Specialist

　　ID: 5618

　　Department: Quality Improvement

　　Salary Range: N/A

　　Employment Status: Full-time

　　Description

　　POSITION SUMMARY

　　Responsible for conducting clinical and billing audits, along with reviewing monitoring reports. Follows agency audit plan. Provides backup to other staff members within the Quality Improvement Department.

　　ESSENTIAL DUTIES AND RESPONSIBILITIES

　　The essential functions include, but are not limited to the following:

　　• Conducts audits per agency audit plan and as directed by the QI/Compliance Manager. Writes clear, concise summaries and detailed reports. Provides recommendations for improvements and/or corrective action.

　　• Assists with providing documentation training for new employees and contractors as well as technical assistance for documentation/billing requirements.

　　• Helps identify agency training needs. Assists with developing training and provides trainings as directed by manager.

　　• Assists with developing training materials to be utilized by staff.

　　• Provides support for Avatar documentation/billing concerns. Assists QI staff with making documentation corrections in the EMR.

　　• Follows-up on internal audits and regulatory inspection reports and action plans to assure the timely completion of corrective actions.

　　• Assists in coordinating efforts to ensure clients receiving telehealth only services are seen in person per state guidelines.

　　• Maintains full knowledge of agency policies and procedures, service codes and definitions, and regulatory guidelines and directives. Serves as point of contact for employees and contractors regarding documentation and regulatory requirements.

　　• Reviews routine monitoring reports to ensure compliance in EMR. Communicates with staff and supervisors to ensure corrections are made in the EMR as needed.

　　• Assists with licensing, accreditation, and agency credentialing/re-credentialing process.

　　• Provides back-up for UM Coordinator for therapy referrals and high-risk review.

　　• Provides back-up for Compliance Specialist for practitioner credentialing and privileging.

　　• Assists with outcome data collection and reporting as needed.

　　• Provides other trainings as directed by the manager.

　　MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)

　　Education/Certifications:

　　• Bachelor’s Degree Required

　　• Qualified Mental Health Professional Preferred

　　Experience Required:

　　• 1 to 3 years minimum work-related experience required

　　• 3+ years minimum work-related experience preferred

　　Required Knowledge:

　　• Proficiency with Microsoft Office Suite

　　• Knowledge of CARF standards, Missouri Department of Mental Health, and Missouri Medicaid billing rules preferred

　　• Experience with Electronic Health Records

　　Skills/Abilities:

　　• Excellent communication skills, both written and verbal.

　　• Strong ability to multi-task with a high level of accuracy and timeliness in project output.

　　• The ability to maintain a high level of client confidentiality.

　　• Excellent oral and written communication skills; ability to present complex information in an understandable manner

　　• Excellent critical thinking and problem-solving skills

　　• Strong interpersonal, communication and collaboration skills

　　• Ability to work collaboratively with staff at all levels

　　• Ability to research and understand billing and documentation requirements