CLINICAL AUDIT SPECIALIST

CATHOLIC CHARITIES FAMILY AND COMMUNITY SERVICES•City of Rochester, NY

5h•$62,353 - $65,000•Hybrid

About The Position

The Clinical Audit Specialist conducts objective, clinically rigorous chart reviews using the organization’s OMH and OASAS aligned Clinical Review Tools to ensure compliance with OMH and OASAS regulatory standards, accuracy of clinical information, and adherence to organizational policies. This role supports quality improvement initiatives and helps maintain high standards of an individual’s care. This role functions as an independent clinical quality assurance resource, ensuring documentation accurately reflects clinical work provided, supports medical necessity, and meets regulatory and payer requirements. The position operates within a continuous quality improvement (CQI) framework, emphasizing strengths-based feedback, targeted coaching, and linkage to training rather than disciplinary action.

Requirements

Master’s Degree in Social Work, Mental Health Counseling, Psychology, Nursing or related field.
Equivalent combination of education and experience will be considered.
2+ years of behavioral health clinical experience, familiarity with electronic health record (EHR) systems.
Familiarity with NYS OMH including HCBS and OASAS regulations and Medicaid Managed Care requirements.
Familiarity with OMIG audit processes and Medicaid documentation.

Nice To Haves

Licensed Master Social Worker (LMSW) preferred.
Preferred experience in quality assurance, utilization review or clinical auditing.
Experience with Trauma-Informed care and integrated behavioral health models.

Responsibilities

Coordinates with Director of Quality Assurance and Compliance annual schedule of clinical audits.
Conduct routine, focused and follow up clinical chart audits using standardized tools to ensure completeness, accuracy, and compliance with state, federal and organizational guidelines.
Identify documentation gaps, inconsistencies, or errors and communicates findings to clinical staff for correction.
Reviews documentation across assessment, treatment planning, progress notes, group documentation and discharge planning
Apply consistent scoring aligned with established standards and interpretation guides
Ensures charts meet requirements of HIPAA, Joint Commission and other applicable regulations.
Identifies documentation strengths and improvement opportunities and collaborates with supervisors and clinicians to support remediation.
Develops and supports strength based Corrective Action Plans when indicated.
Supports peer reviewers and supervisors in understanding audit standards
Prepares summaries and reports of audit findings for management and quality improvement committees.
Link audit findings to appropriate training and Continual Quality Improvement initiatives
Contributes to identification of system-level trends and documentation gaps
Assists in developing educational material related to documentation, compliance or procedures
Investigates and monitors issues of non-compliance and coordinates with the program to implement appropriate internal controls
Recommends future course of action based on audits and data analysis
Conducts training and provides updates regarding internal controls and regulatory compliance
Adheres to all applicable federal and state laws, as well as CCFCS internal policies, including but not limited to those governing client confidentiality, privacy, program standards and billing and documentation standards
Maintains high level of expertise in specialized areas through continuing education, individual contacts, and attendance at appropriate meetings
Attend mandatory training.
Actively pursues development of professional competencies related to job performance through reading, supervision, in-service training and attendance at conferences and workshops.
Attend staff meetings and other agency committee meetings as appropriate to duties and responsibilities and communicate information directly to appropriate staff.
Represent Catholic Charities Family and Community Services on appropriate committees.
Awareness and active support of the Agency's Mission, Vision, Values and Strategic Plan. Including, but not limited to, supporting the Agency's Core Competency initiatives of being Collaborative and Community Focused, Innovative and Entrepreneurial, and Culturally Competent and Diverse.
Other duties as assigned