Regional Continuous Quality Improvement Specialist

Hourly Range: $36.05 - $49.58 DOE 

Job Summary:

Under the direction and supervision of the Director of Quality, the Regional Continuous Quality Improvement (CQI) Specialist assists with ensuring the highest quality of care and service delivery to clients and families of Victor. This individual has extensive knowledge in federal, state, and region-specific regulations. They ensure a comprehensive system of Continuous Quality Improvement (CQI) and the integrity of all relevant documentation and billing practices. They provide region specific training and systems development relative to compliance and privacy systems.

Primary Responsibilities:

1. Provides region specific quality assurance with specific focus on accurate billing and claim processes.
2.  Collaborates closely with the Revenue Manager and Regional Billing Managers to develop, maintain, and support an accurate and efficient billing and clinical documentation process to ensure quality claim submission.
3. Supports the agency with regional knowledge relating to Specialty Mental Health Services Medi-Cal Billing Manual and Medi-Cal documentation protocols.
4. Conducts routine, region specific, chart audits, compiles formal and informal reports and ensures adherence to accurate service delivery, billing, and documentation practices.
5. Attends County CQI meetings and trainings to ensure ongoing expertise of county related processes.
6. Acts as a regional liaison within and without the organization regarding privacy, compliance, and CQI requirements and ensures thorough communication to the Agency Executive Leadership regarding matters of service excellence and relevant documentation and billing practices.
7. Maintains expertise in Federal, State and County regulations/policies to ensure the prevention of fraud, waste and abuse.
8. Provides consultative support and training to ensure quality throughout agency billing, compliance and privacy systems.
9. Assists Director of Quality with maintenance and oversight of Agency HIPAA Manual, including HIPAA policies and procedures, and ensures all federal and state privacy regulations are met. Responds to region specific reports of privacy/compliance breaches and ensures all regulations for reporting, both internal and external, are adhered to.
10. Responds to region specific reports of privacy/compliance breaches and ensures all regulations for reporting, both internal and external, are adhered to.
11. Participates in the process of ensuring full integration of Agency service, documentation and accurate billing practices with the Electronic Health Record, including development and maintenance.
12. Completes other duties as assigned.

Essential Requirements:

1. Completion of a program of study with Masters’ or Doctorate degree in a field of behavioral science or related field from an accredited educational institution.
2. Minimum two years of experience collaborating with internal and external leadership.
3. Must have excellent verbal and written communication skills and demonstrated ability to work independently while maintaining connection to team and supervisor.
4. Minimum 5 years of experience navigating Medi-Cal regulations, including but not limited to extensive understanding of documentation and billing standards and audit protocols.
5. Minimum of five years of experience navigating county, state and federal regulations with strong ability to interpret and communicate regulations to internal and external stakeholders.
6. Ability to analyze risk and make calculated decisions taking into account agency and stakeholder needs.

Desired Requirements

1. Certification in Healthcare Compliance and Healthcare Privacy Compliance is preferred.

Salary : $36 - $50