Quality Assurance (QA) Reviewer II

SpectraCare•Dothan, AL

8d•Onsite

About The Position

Quality Assurance (QA) Reviewer II This position will be located at our Administration Office in Dothan, AL Monday - Friday 8am - 5pm Alabama State Retirement Responsibilities: Maintains files on: Clinical policies and procedures for Mentally Ill, Developmental Disabilities and Substance Abuse Divisions. Medicaid regulations and requirements. Medicare regulations and requirements. Department of Mental Health regulations and requirements. Any other relevant funding or compliance agency regulations and requirements. Performs routine reviews checking for compliance to Department of Mental Health, Medicaid, Medicare and applicable billing requirements for: New employees within six (6) months of hire. Terminated, resigning or transferring therapists. Minimum of 10 % of clinician’s caseload annually (preferably 3% - 5% quarterly). Income verification and reimbursement source versus printout. Performs audits on or by: Medicaid review of charts Medicare/Other Insurance Self Pay Status Clinician Clinical aspects of services Billing Income verification and reimbursement source versus printout Receipt sequence report Follows up on deficiencies and reports trends/findings to Chief Compliance Officer. Investigates Special Incidents as needed. Other duties as assigned by Chief Compliance Officer. Regular attendance with timely arrival and departure according to scheduled hours

Requirements

Master’s degree or above from an accredited college or university in psychology, social work, counseling, or other behavioral health area with requisite course work equivalent to that of a degree in counseling, psychology, or social work.
Minimum two (2) years’ clinical experience required.
Personal computer background with familiarity and training in word processing, spreadsheets and data base management.
Valid driver’s license and good MVR.
Must meet insurability requirements to drive a system vehicle (21 years of age).

Nice To Haves

At least two (2) years’ experience operating an EMR system
Four (4) or more year’s clinical experience in a mental health, business, computer science or related field.
Strong business background preferred

Responsibilities

Maintains files on: Clinical policies and procedures for Mentally Ill, Developmental Disabilities and Substance Abuse Divisions.
Maintains files on: Medicaid regulations and requirements.
Maintains files on: Medicare regulations and requirements.
Maintains files on: Department of Mental Health regulations and requirements.
Maintains files on: Any other relevant funding or compliance agency regulations and requirements.
Performs routine reviews checking for compliance to Department of Mental Health, Medicaid, Medicare and applicable billing requirements for: New employees within six (6) months of hire.
Performs routine reviews checking for compliance to Department of Mental Health, Medicaid, Medicare and applicable billing requirements for: Terminated, resigning or transferring therapists.
Performs routine reviews checking for compliance to Department of Mental Health, Medicaid, Medicare and applicable billing requirements for: Minimum of 10 % of clinician’s caseload annually (preferably 3% - 5% quarterly).
Performs routine reviews checking for compliance to Department of Mental Health, Medicaid, Medicare and applicable billing requirements for: Income verification and reimbursement source versus printout.
Performs audits on or by: Medicaid review of charts
Performs audits on or by: Medicare/Other Insurance
Performs audits on or by: Self Pay Status
Performs audits on or by: Clinician
Performs audits on or by: Clinical aspects of services
Performs audits on or by: Billing
Performs audits on or by: Income verification and reimbursement source versus printout
Performs audits on or by: Receipt sequence report
Follows up on deficiencies and reports trends/findings to Chief Compliance Officer.
Investigates Special Incidents as needed.
Other duties as assigned by Chief Compliance Officer.
Regular attendance with timely arrival and departure according to scheduled hours