Quality Assurance Specialist
About The Position
Counseling 4 Kids is a community mental health agency committed to quality care and client engagement. The agency values innovation, teamwork, and resilience, fostering a supportive and inclusive atmosphere for professional growth. This role is a contracted position with an expected duration of six months. At the end of the contract, performance will be evaluated to determine if the contract will be extended, if the employee will be offered a full-time position, or if the contract will end. The Quality Assurance Specialist (QAS) assists Counseling4Kids (C4K) in maintaining compliance with agency, Los Angeles County Department of Mental Health’s (DMH), and state requirements (DHCS and Medi-Cal) for Mental Health Treatment. Under the guidance of the Quality Assurance and Improvement Director (QAID), the QAS participates in Quality Assurance (QA) and Quality Improvement (QI) activities. This includes chart reviews, data entry, documentation tracking, monitoring contract performance, and assisting with staff training. The ideal candidate is tech-savvy, detail-oriented, able to work independently, collaborative, demonstrates initiative and curiosity, and is willing to support colleagues and client services.
Requirements
- BA in healthcare administration, psychology, social work, public health, or related field -OR- AA degree in related field and minimum of 2 years relevant work experience
- Two (2) or more years’ work experience within a healthcare setting
- Experience with DMH policies, procedures, tracking/reporting systems preferred
- Knowledge of billing codes and/or processing claims preferred
- Knowledge of HIPAA and client privacy standards
- Experience with Electronic Health Records, preferably Exym
- Skilled use of Microsoft Suite (i.e. Outlook, Word, and Excel)
- Clear written and verbal communication skills with the ability to be resourceful and proactive when issues arise.
- Bilingual English/Spanish preferred
Nice To Haves
- Experience with DMH policies, procedures, tracking/reporting systems
- Knowledge of billing codes and/or processing claims
- Bilingual English/Spanish
Responsibilities
- Upholds compliance with HIPAA, mandated reporting, and other healthcare laws and agency policy
- Processes record requests, distribution of information, and/or communication within laws & regulations
- Implements timely data collection, entry, and reporting within agency standards and to meet contract requirements
- Completes administrative reviews of clinical records, updates reporting on client admission, engagement, and discharge dates, and assists with evidence-based practices (EBPs) compliance.
- Tracks outstanding compliance issues to ensure resolution in timely manner
- Participates in agency goal of 5% utilization reviews of active clients on a quarterly basis and updates tracking
- Track corrections and completion of compliance forms, completes regular data entry within DMH systems for staffing and program tracking
- Process requests for Client Information and Disclosures as directed
- Perform quality survey calls with community-based clients, as directed by QAID
- Attends internal departmental, agency-wide, and county-wide meetings, as directed by QAID
- Seeks technical support both internally and externally to resolve issues related to quality and compliance
- Assists with committee events and transportation of necessary items, as requested
- Completes staff enrollment and disenrollment within internal and external systems (i.e. Exym and NAPPA)
- Supports billing processing and resolving outstanding claim issues, by problem solving errors and issues related to staff profiles, billing code usage, and/or cross-system communications (i.e. Exym, NAPPA, IBHIS)
- Manage staff certification tracker and collaborate across departments for certificate renewal, as needed
- Complete client program changes in EXYM (i.e. changing funding source, program type, EBP, etc.)
- Collaborate with QA/QI team to resolve discrepancies within, but not limited to: Diagnosis (EXYM/IBHIS) reports; problem List/SNOMED-CT updates; client profiles in IBHIS, EXYM and Medi-Cal systems; Psychiatric consents
- Reviewing, tracking and filing of consumer perception surveys (CPS) to ensure that departmental completion rate goals are achieved
- Serves as a support role for quality assurance training during onboarding of new staff
- Participates in agency training to maintain current knowledge of quality assurance policies and procedures. Assists with the development of training materials for assigned projects
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Career Level
Entry Level
Education Level
Associate degree
