QI Compliance Manager

Tri-County Mental Health, DBA Beacon Mental Health•Kansas City, MO

13d

About The Position

Responsible for enhancing the quality of services provided, by maintaining an agency wide QI system to meet regulatory and compliance requirements; thereby minimizing risk and improving service delivery. Assumes primary responsibility for the daily functions and operations of the QI department which includes oversight of the positions responsible for outcomes, credentialing, accreditation, utilization management and auditing/monitoring.

Requirements

Masters Degree required
3+ years of position related experience required.
Basic Knowledge of Microsoft Office Suite (Word, Excel, Power Point)
Experience with Electronic Health Records

Nice To Haves

Clinically Licensed or Provisionally Licensed preferred
Direct supervision of staff preferred.
Knowledge of CARF and CCBHC Standards, Missouri Department of Mental Health regulations, and Missouri Medicaid billing rules preferred.
Knowledge of value-based measures and reporting
Knowledge of credentialing and privileging requirements and processes
Knowledge of data collection, analysis, statistics, and data presentation
Crystal Report writing skills and experience a plus
Excellent communication skills, both written and verbal.
Strong ability to multi-task with a high level of accuracy and timeliness in project output.
Ability to present complex information in an understandable manner.
Ability to maintain a high level of client confidentiality.
Excellent critical thinking and problem-solving skills.
Strong interpersonal, communication and collaboration skills.
Ability to work collaboratively with staff at all levels.
Ability to research and understand billing and documentation requirements.

Responsibilities

Provides direct supervision of the Outcomes Specialist, Compliance Specialist, QI Coordinator, Utilization Management Coordinator, and Auditing positions to include regular supervision, training, assignment of work, policy/procedure compliance, and performance reviews.
Provides overall oversight of the documentation/billing corrections ticket system.
Develops department goals. Participates in the development of budgeting and has direct responsibility for adhering to those goals.
Develops and provides training to other departments as needed related to documentation and billing requirements.
Responsible for coordinating internal and contract provider audits for clinical programs in conjunction with department managers. Communicates with managers to coordinate and prioritize auditing and compliance needs.
Coordinates with HIM department to ensure that chart requests from payors are completed accurately and timely by reviewing documentation prior to it being sent.
Maintains full knowledge of agency policies and procedures, service codes and definitions, and regulatory guidelines and directives. Serves as primary point of contact for employees and contractors regarding documentation and regulatory requirements.
Prepares for and coordinates Department of Mental Health audits, Mental Health Tax Levy audits, CCCSF audits, and CARF surveys.
Follows up on internal audits and regulatory inspection reports and action plans to assure the timely completion of corrective actions.
Assists in the investigation of regulatory concerns as directed by the CQCO.
Coordinates with the Billing Team as needed to investigate denials due to diagnosis code, billing code/modifier, and provider not eligible.
Serves as member of Quality Improvement, Avatar, and Compliance Committees.
Maintains knowledge of agency technology programs and/or systems needed to do the job and uses them effectively.
Other duties and/or responsibilities that may be assigned.