Medical Care Specialist

Advantage Behavioral Health Systems•Athens, GA

1d•Remote

About The Position

The Medical Care Auditor is responsible for reviewing, analyzing, and auditing medical documentation, records, and related processes to ensure compliance with regulatory standards, internal policies, and quality initiatives. This role supports client safety, accurate reporting, and continuous improvement of behavioral health services

Requirements

Bachelor’s degree in nursing, Healthcare Administration, or related field (required).
Experience in medical auditing, quality assurance, or compliance within a healthcare setting.
Strong knowledge of medical terminology, healthcare regulations, and documentation standards.
Excellent analytical, organizational, and communication skills.
Proficiency in electronic medical record (EMR) systems and Microsoft Office Suite
Current RN license

Responsibilities

In collaboration with the agency's Quality Assurance Department, Director of Medical Services, and Human Resources, responsible for developing comprehensive training programs for both new and existing medical staff, including Nurses, Nurse Practitioners (NPs), Advanced Practice Registered Nurses (APRNs), and Medical Doctors (MDs).
Develops training materials that are aligned with quality standards, compliance regulations, and the requirements set forth by governing bodies (such as regulatory agencies or accrediting organizations).
Conducts New Employee Orientation (NEO) sessions for onboarding medical staff during the 1st and 3rd designated NEO weeks, or on alternate days as needed, ensuring consistent introduction to agency policies, procedures, compliance standards, and role expectations.
Ensures the effectiveness of training programs by developing competency assessments, reviewing documentation and making necessary adjustments to training content.
Provides timely and constructive feedback to support staff development.
Provides training on Electronic Medication Administration Records (eMAR) and order entry that is tailored to the credentials, scope of practice, and roles of the medical provider.
Annually conducts audits of 5% of active clients receiving medical services within the Behavioral Health (BH) and Intellectual and Developmental Disabilities (IDD) programs to ensure quality of care, compliance with documentation standards, and adherence to agency and regulatory requirements.
Creates audit tools that considers quality, compliance, service and billing requirements of psychiatric and nursing services.
Prepares and presents quarterly reports to program and executive leadership, highlighting audit results, training outcomes, and emerging trends, to support data-driven decisions and continuous quality improvement.
Identifies patterns, trends, and areas for improvement through data analysis, audits, and contributes to staff performance reviews.
Contributes to the development of targeted training and quality enhancement strategies.
Participates in special projects and new implementations by contributing medical expertise and operational insight to support successful planning, execution, and integration into existing workflows.
Coordinates, trains, and assists medical providers with documentation, assessments, and the implementation of new platforms, ensuring smooth adoption and effective use of technology in clinical practices.
Collaborates with Quality Improvement Department (QID) and Billing team to append and review documentation related to medical services, ensuring accuracy and completeness for proper billing and payment processing.
Processes medical services tickets related to documentation, diagnosis, and billing issues, facilitating timely resolution and maintaining accurate clinical and financial records.
Provides technical assistance to medical staff in using the Electronic Health Record (EHR) system, Orders Console, and Electronic Medication Administration Record (eMAR) to ensure efficient and accurate documentation and order processing.
Reviews medical documentation to identify necessary corrections and ensure accuracy.
Appends documentation for medical providers when verified adjustments are required, maintaining completeness and compliance
Works collaboratively with cross-functional departments to improve documentation, optimize systems, and enhance workflow efficiency.
Collaborates closely with the Director of Nursing Services to support department and agency goals.
Provides updates on audit reports, emerging trends, and identified issues.