Quality Assurance Specialist

True North Recovery Inc•Wasilla, AK

About The Position

The Quality Assurance Specialist oversees billing and documentation compliance with contractual obligations, mandates, state laws and regulations, subcontractual agreements, HIPAA, Medicaid, and agency policies and procedures. The role provides training and feedback to service delivery staff on areas requiring correction or improvement and works collaboratively with supervisors and management to support the accuracy and quality of client documentation, services, and records. The position reviews documentation submitted to substance use disorder (SUD) client records and ensures that medical necessity is documented through the “Golden Thread” in accordance with TNR and state policies and procedures. It also involves administrative support, data entry, client-record maintenance, handling telephone inquiries, and maintaining confidentiality.

Requirements

High school diploma or GED preferred.
At least 6 months of experience in administrative support or a clerical field.
Experience with Microsoft applications and basic computer programs.
Computer skills, including spreadsheet, word-processing, and publishing programs.
Excellent written and verbal communication skills, with good vocabulary, spelling, and proofreading skills.
Strong research skills.
Strong customer service and interpersonal skills.
Demonstrated ability to work independently with limited supervision.
Demonstrated ability to coordinate multiple activities.
Demonstrated understanding of substance use disorders and recovery-oriented approaches to care.
If in recovery, at least one year of continuous sobriety before hire and an ongoing commitment to personal recovery through practices supporting self-care, health, and overall well-being.

Nice To Haves

Prior customer service experience.
Prior experience with an electronic health records system.

Responsibilities

Review documentation submitted to SUD client records for content and compliance, including intake documents, assessments, treatment plans, progress notes, diagnosis changes, outcome measures, collateral documents, and correspondence.
Ensure the client record documents the “Golden Thread” of medical necessity in accordance with TNR and state policies and procedures.
Provide training and feedback to service delivery staff on areas needing correction or improvement.
Collaborate with supervisors and management to ensure the accuracy and quality of client documentation, services, and records.
Answer telephone inquiries, refer callers to appropriate staff, and return messages.
Enter intake packet information into the EHR.
Obtain service authorization through the Medicaid site and enter authorization information into the EHR.
Create paper and electronic records for clients.
Maintain inactive files in proper order and shred unnecessary documents.
Assist the program manager, specialists, and executive director with proofreading, data entry, and clerical work as requested.
Use general office equipment, including copy machines, printers, and facsimile machines.
Maintain confidentiality in accordance with regulations and policy.
Perform other duties as assigned.

Benefits

ICHRA coverage for employee health insurance policy reimbursement.
401(k) plan with a 100% match up to 5%.
Life and accidental death and dismemberment insurance fully covered by the employer.
Vision and dental policy with 90% of the cost covered by the employer.
10 paid holidays per year.
Accrued paid time off.
Paid training and credentialing.
Short-term and long-term disability.
Monthly cash stipend.
Supplemental benefits, including critical illness insurance, accident insurance, and hospital indemnity.