Clinical Quality Assurance Specialist

BetterHelp

20h•Remote

About The Position

BetterHelp is seeking a meticulous Clinical Quality Assurance Specialist to join their clinical operations team. This role is crucial for ensuring the highest standards of clinical documentation and care delivery within their insurance-covered services, especially as they expand insurance partnerships and serve clients through value-based care arrangements. The specialist will conduct comprehensive clinical chart audits, evaluate adherence to evidence-based treatment standards, and support the operational excellence of quality review processes. This position requires exceptional attention to detail, strong clinical judgment, and the ability to identify clinical improvement opportunities while ensuring compliance with insurance requirements and regulatory standards. Reporting to the practice management team lead, this role offers the opportunity to directly impact the quality of care delivered to thousands of clients and support BetterHelp's mission to make mental health care accessible and effective.

Requirements

Master's or Doctoral degree in psychology, clinical social work, counseling, psychiatry, or closely related mental health field
Current, active clinical license in good standing (LCSW, LPC, LMFT, PsyD, PhD, MD, or equivalent)
Minimum 2+ years of clinical practice experience with direct patient care and clinical documentation
Strong understanding of evidence-based mental health treatment practices and clinical documentation standards
Exceptional attention to detail with ability to identify discrepancies and areas for improvement in clinical records
Experience with electronic health records (EHR) systems and clinical documentation platforms
Excellent written and verbal communication skills with ability to provide constructive feedback to clinical colleagues

Nice To Haves

Experience with clinical auditing, quality assurance, or utilization review in healthcare settings
Knowledge of insurance requirements, medical necessity criteria, and value-based care standards
Background in virtual care delivery or digital health platforms
Familiarity with regulatory requirements for mental health services and clinical documentation
Experience working with diverse clinical teams and providing clinical supervision or consultation

Responsibilities

Conduct thorough clinical chart audits to ensure compliance with BetterHelp's clinical standards of practice and evidence-based treatment protocols.
Review patient documentation for accuracy, completeness, and adherence to regulatory requirements and insurance coverage criteria.
Evaluate treatment planning, progress notes, and clinical decision-making against established clinical guidelines and best practices.
Identify patterns of clinical excellence and areas for improvement in documentation and care delivery.
Maintain detailed audit findings and recommendations in compliance with quality assurance protocols.
Support the day-to-day operations of the quality assurance team, including audit scheduling, tracking, and reporting.
Participate in preparing necessary documentation for insurance audits. Download the requested patient records and policies & procedures.
Collaborate with clinical teams to address audit findings and implement corrective action plans.
Assist in developing and refining clinical audit tools, checklists, and evaluation criteria.
Contribute to quality assurance training materials and educational resources for clinical staff.
Participate in quality improvement initiatives based on audit findings and clinical trends.
Ensure all clinical chart reviews meet insurance payer requirements and regulatory standards.
Monitor compliance with state licensing requirements, professional practice standards, and accreditation criteria.
Support preparation for external audits and regulatory reviews by maintaining comprehensive documentation.
Stay current with evolving insurance requirements and clinical practice standards that impact quality assurance processes.
Collaborate with compliance teams to address any regulatory or contractual requirements identified through audit processes.