Quality Assurance Specialist (Compliance Specialist)

Mental Health Systems, Inc. • Chula Vista, CA

81d

About The Position

The Compliance Specialist (CS) aids in development, administration, and maintenance of systems to ensure compliance with County and State Medi-Cal (MC) requirements and Medicare requirements, in addition to ensuring accurate data collection and verification using InSyst and/or other information databases. The CS also performs other duties, as assigned by the Program Manager.

Requirements

• Bachelor of Arts degree in a social services or related field preferred.
• Master’s degree in human services field highly valued.
• One-year experience working with participant charts.
• Two years of administrative experience.
• Proficient user of Microsoft Office Suite and EHR software.
• Ability to problem solve and react appropriately to emergency situations.
• Ability to work independently and effectively collaborate with a team.

Responsibilities

• Maintains systems for accurate service data entry and tracking for program services.
• Develops and maintains effective liaison with County behavioral health department.
• Reviews and tracks all service data reports to ensure accurate data entry and billing processes.
• Completes regular quality improvement reviews of client charts.
• Facilitates Peer Review process for treatment programs.
• Conducts HIPAA Site Reviews for program.
• Monitors and supports the completion of chart archiving for programs.
• Supports program preparation for all site reviews and chart audits and participates actively during reviews/audits.
• Organizes documentation requirements for audit appeals or plans of correction.
• Provides training to staff relevant to all needed areas of chart documentation and contract compliance.
• Represents Mental Health Division at community and other agency QI meetings and functions.
• Maintains professional currency by reading appropriate publications, attending seminars, and other training, as necessary.
• Consults with supervisor and Department and Division staff, on a regular basis to ensure program development.
• Demonstrates excellent written and oral communication skills.
• Exhibits management ability to plan, prioritize, control, and evaluate at a level sufficient to ensure the efficiency, effectiveness and success of the program.
• Fosters effective communications and interpersonal relationships with co-workers and staff.
• Displays resourcefulness, initiative, and the ability to work with minimal direction and supervision.
• Speaks well and in an organized manner when making public presentations.
• Complies with all MHS and program rules, policies and procedures including HIPAA standards.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees