Quality Assurance Specialist

JOB DESCRIPTION

Under the supervision of the Quality Assurance Supervisor, the ideal incumbent will conduct internal audits of client medical records that are related to the requirements set by Medi-Cal; prepare internal reports detailing the audit findings; provide targeted trainings for program staff, including group trainings, 1:1 trainings, and training clinical staff; conduct follow up reviews to ensure that chart deficiencies have been corrected by program staff; and attend all Medi-Cal documentation related meetings and trainings at MCBH to disseminate relevant information to staff, as needed.  This position is responsible for efforts to reduce fraud, waste, and abuse disallowances from funding sources due to improper charting and billing and ensuring that documentation is accurate. In addition, the position is responsible for making recommendations to improve the quality of programs and program outcomes. This position will also be involved with Interim's commercial insurance clients, including but not limited to responding to inquiries, insurance verification, screening clients for program placement based on needs, etc.

WHO WE ARE

Looking to make a difference? Our mission at Interim is to provide services and affordable housing to supporting members of our community with mental illness by building productive and satisfying lives in a world in which people with mental illness are able to live, work, learn and participate fully in the community. Join our team and instill hope in the community.

WHAT WE OFFER

• Competitive Compensation
• Tuition reimbursement for eligible positions
• Clinical licenses and training reimbursement for eligible positions
• Loan repayment for eligible positions
• Generous health, vision, dental, Employee Assistance Program (EAP), and life insurance coverage for full-time employees
• Monthly payment in lieu of insurance coverage for eligible positions
• 403b Retirement Plan with Interim matching contribution
• Competitive vacation and sick leave accruals. You can earn up to 24 days of vacation in your first year.
• Professional development and learning opportunities.
• BBS registered supervisors onsite for ongoing Clinical Supervision
• Annual employee recognition and staff appreciation events
• Employee referral bonus program
• Offers flexible work schedules
• A fulfilling career while providing a family centered focus and work-life balance

HOW TO APPLY

To learn more about Interim and to apply for this position, please go to our website at http://www.interiminc.org/employment/.

COMPENSATION

$36.20 - $47.14 per hour. Non-exempt; 40 hours/week; Eligible for overtime. Compensation based on education and experience.

REPORTS TO

Quality Assurance Supervisor

QUALIFICATIONS

Required: Master's degree in social work, psychology or related mental health field, plus be licensed (or be licensed within two years) as Clinical Psychologist, Licensed Clinical Social Worker, Marriage and Family Therapist, or Professional Clinical Counselor; at least two years’ professional experience providing direct services or supervision of services such as case management and/or mental health services, crisis residential, transitional residential treatment, or day rehabilitation to a client population of adults or children with psychiatric challenges. Experience should include documentation responsibility and a demonstrated familiarity with Medi-Cal rules and regulations. Excellent computer skills related to Microsoft Office (Word, PowerPoint, Excel).  Must have knowledge of electronic health/medical records systems, i.e., preferably Avatar.

Preferred: Be familiar with ICD-10 and DSM-5 diagnostic criteria. Strong interpersonal skills and oral/written communication skills. Strong public speaking skills and comfortable speaking and training in 1:1 and group settings. Ability to deal effectively with diverse individuals and personality types, regardless of ethnicity, race, gender identity, religious background, or socio-economic level. Knowledge of working with private insurance companies and experience coordinating services, including insurance verification, managing client share of cost, and collaborating with various programs to ensure the delivery of appropriate care.

Driver’s license for at least two years and driving record acceptable to insurance carrier.

Valid California driver's license; auto in safe operating condition; auto liability insurance; good driving record; criminal record clearance; proof of authorization to work in the United States as required by Immigration and Reform Act of 1986. Ability to work independently with minimal supervision.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Under the supervision of the Quality Assurance Supervisor, the Quality Assurance Specialist I, will perform and assist with the following duties:

Liaison and Client Communication:

1. Conduct initial screenings and discuss program options for potential commercial insurance and private pay clients via phone calls and email inquiries.
2. Liaison between commercial insurance and private pay clients to Interim programs, including insurance verification, following up with potential clients to communicate share of cost, follow up on required documents needed per program, and communicating with Licensed staff conducting initial evaluations.

Training and Development:

1. Conduct continuous training sessions on writing Group Notes, inputting them into Avatar, generating Group Descriptions, and crafting Group Action Steps and Supports within Treatment Plans.
2. Provide documentation training to new Counselors, Clinicians, Nursing Staff, MSW Interns, and Wellness Navigators upon hire, enabling them to begin program documentation promptly.
3. Provide follow-up feedback to new staff who have received new hire documentation training and provide further support or training as needed to improve documentation content, timeliness, scope of practice, fraud/waste/abuse, etc.
4. Develop Medi-Cal training sessions for bi-monthly audits, delivering clear and concise presentations to program staff through handouts or PowerPoint slides.
5. Assist in creating training handouts for program staff to assist in improving documentation, including but not limited to examples of Progress Notes by billing code, examples of Progress Notes by special circumstances, documenting within scope of practice/competence, etc.
6. Assist in developing and updating program Documentation Guides with most up to date Medi-Cal standards.
7. Provide training to CCL programs in Appraisal Needs and Service Plan requirements.
8. Assist in providing training to new Administrative Assistants, including intake procedures, intake forms, discharge procedures, error reporting, FSP forms, etc.
9. Provide detailed feedback to program managers/supervisors following training of new staff and include strengths and areas of needed improvement.

Program Support:

1. Assist in consultation with Licensed staff conducting evaluations for commercial insurance or private pay clients to assess for diagnostic criteria and program appropriateness.
2. Enter admission, update, and discharge diagnoses in a timely manner as a backup to all programs in case of clinical staff absences.
3. Support program managers/supervisors and division directors in developing strategies to enhance units of service as required.
4. Provide as needed support to staff via phone, email, zoom, or in person as requested by individual staff, program manager/supervisor, or QA supervisor related to documentation.

Accreditation & Quality Assurance:

1. Attend MCBH Utilization Review Meetings and assist QA Supervisor with Corrective Action Plans accordingly.
2. Assist the QA Supervisor with the administrative process for the agency’s re-accreditation or accreditation of programs by CARF (Commission on Accreditation of Rehabilitation Facilities) as needed.

Compliance & Audits:

1. Conduct internal audits of client records and any other relevant documents by following the requirements and guidelines set forth by Medi-cal regulations.
2. Monitor Error Reports submitted by staff in Avatar to verify resolution status and engage with staff and supervisors as necessary to ensure follow-up.
3. Possess a good knowledge base of the MCBH and Medi-Cal billing requirements as described in their Documentation Guide, in addition to understanding MCBH billing system requirements for reporting units.
4. Assist with twice monthly Medi-Cal audits of individual staff per program and provide detailed feedback on strengths and areas of needed improvement, including requesting error reports.
5. Assist with necessary FSP compliance tracking by emailing programs when forms need entering or updating, such as Quarterly Assessment Forms, Partnership Assessment Forms, Key Event Tracking, and UMDAP/Family Registration.
6. Monitor CalAIM assessments and other annual plan-required forms and notify assessment writers or case coordinators via email regarding any missing items.
7. Review charts for compliance with Discharge Procedures upon program request when closing an Avatar episode or as requested by the Deputy Director or QA Supervisor in cases of client passing or other exceptional circumstances.
8. Track 72-hr compliance by running monthly reports and informing program supervisors of areas of needed improvement.
9. Initiate random audits of individual staff to track weekly and monthly productivity and inform supervisors of needed areas of improvement, including detailed observations and recommendations for areas of training.
10. Assist QA Technicians in sending compliance reports as needed, such as those for clients without a diagnosis, duplicate services, clients without services for 60 days, etc Other duties as assigned.

PHYSICAL REQUIREMENTS

Ability to: operate a motor vehicle; climb stairs; possess good communication skills; meet the requirements of the classification and have mobility, vision, hearing and dexterity levels appropriate to the duties to be performed. See well enough to read data on a computer screen and text in written documents; perform extensive computer keyboard operations. Capable of the following extended activities: walking, standing, sitting, climbing stairs. Capable of the following intermittent activities: stooping, kneeling, lifting 25 pounds or more and bending in the performance of infrequently performed office duties.

This job description is intended to have an accurate reflection of the qualifications and job duties; current management reserves the right to revise the job at any given time when circumstances change. This job description replaces all previous description for this position.

Interim, Inc. is an equal opportunity employer.

Interim Inc. is guided by the precept that in no aspect of its programs, services or employment practices shall discrimination be permitted because of race, color, national origin, gender, age, creed, religion, physical or mental disability, marital status, medical condition, pregnancy, childbirth, or related medical condition, citizen status, veteran status, military status, sexual orientation, gender identity, or other characteristic protected by state or federal law.  To comply with the Americans with Disabilities Act and other applicable laws ensuring equal employment opportunities to qualified individuals with a disability, reasonable accommodations are made for the known physical or mental limitations of an otherwise qualified individual with a disability, unless hardship, direct threat to health or safety, or other job-related consideration exists.  Individuals who feel that they have been unlawfully discriminated against because of membership in one of the protected classes should contact the following:  Director of Human Resources, Interim, Inc., PO Box 3222, Monterey, CA   93942. (831) 649-4522.

Salary : $36 - $47