Quality Assurance Specialist

Ashland, KY
Full Time
Mid Level

Function:

The Quality Assurance Specialist has the primary responsibility for conducting comprehensive clinical documentation reviews to ensure compliance with federal, state, payer-specific, and agency requirements for clients receiving Behavioral Health Services Organization (BHSO), Alcohol and Other Drug Entity (AODE), Private Child Caring (PCC), Primary Child Placing (PCP) and Primary Care services as well as accreditation standards. This position supports ongoing quality improvement efforts and promotes accurate, timely, and complete documentation of services across all programs.

Organizational duties & responsibilities:

  1. The primary responsibility of all staff is to ensure the safety and well-being of all Ramey-Estep/Re-group (RE) clients.
  2. Supports the mission, vision, and values of RE.  Facilitates and adheres to the agency’s code of ethics, policies, and procedures.
  3. Supports all functions that attain and maintain accreditation and compliance with regulatory agencies.
  4. Supports and facilitates positive interaction with clients and staff by exhibiting both in-office and in-public when carrying out job duties:  individual maturity, respect for others, a team-centered approach, maintenance of confidential information, and awareness and sensitivity to cultural and other differences in clients and staff.
  5. Exhibits effective communication skills, including proper use of agency communication systems.
  6. Participates in appropriate professional development programs to attain and maintain competency.
  7. Effectively manages financial and physical resources to achieve the mission of RE.
  8. Reports incidents of abuse or potential abuse involving clients to the appropriate authorities and RE.

Essential Duties and Responsibilities:

  1. Conducts regular and targeted review of client records across all service lines to ensure documentation meets federal, state, and payer-specific guidelines as well as accreditation standards.
  2. Review service notes, assessments, treatment plans, consents, releases, billing documentation, and other required documentation for accuracy, completeness, timeliness, and medical necessity.
  3. Identify trends in documentation errors or deficiencies and work collaboratively with clinical leadership to provide feedback and training recommendations.
  4. Assist in monitoring compliance with internal policies and external audits (e.g., Medicaid, MCOs, CARF, DBHDID, HRSA, etc.).
  5. Maintain and update internal audit tools and tracking logs to ensure timely resolution of identified issues.
  6. Provide written reports of audit findings with clear recommendations for corrective actions.
  7. Support development and implementation of performance improvement plans (PIPs) related to documentation.
  8. Participate in quality assurance and compliance committee meetings.
  9. Serve as a resource to staff for documentation standards and billing-related requirements.
  10. Completes quality assurance follow-up calls with active and discharged clients to assess overall satisfaction, service quality, and client experience.
  11. Attend quarterly treatment team meetings with assigned service lines to discuss documentation trends, quality concerns, and collaborate on service improvements.
  12. Promotes a positive view of RE and Re-group to the public and outside agencies.
  13. Participates in consultation with the supervisor and other agency employees regularly.
  14. Collaborates effectively with agency employees, supervisors, and leadership and referring agencies and community partners.
  15. Ability to be flexible and adapt to changes in schedules and work environment.
  16. Ensures all necessary records are maintained and kept confidential.
  17. Ensures entries in file reviews and performance improvement plans are done in a professional, concise and timely manner.
  18. Performs other duties as assigned.

Working conditions/environment:

  1. Shift is generally Monday – Friday, but hours will vary.
  2. Holidays, weekends, and extra hours may be required, not to exceed part-time employment hours.
  3. Primary work setting is within the office.
  4. Maintains a positive, professional attitude contributing to a supportive work environment.
  5. The job is primarily completed on the computer and working in ERH.

minimum job requirements:

Education:

Bachelor’s Degree from an accredited university in a clinical field, i.e., social work, counseling, psychology, is required.

Experience:

Previous experience in quality and/or compliance is preferred.
Experience with contracts, licensing, regulations, and accreditation is preferred.
Experience in community-based programs is preferred.

Specific Skills and

requirements:

Must be at least 21 years of age.
Strong leadership and organizational skills.
Excellent communication and conflict resolution skills.
Valid Driver’s License and insurability.
Technical requirements include proficiency with Microsoft Word, Excel, PowerPoint, and any other applications used by the organization or regulatory agencies.
Ability to understand and relate to the needs of clients from diverse backgrounds.
Ability to read, write and converse in English.
Successful completion of a pre-employment drug screen.
Successful completion of a background screening.
Successful completion of a TB skin test or proof of a negative chest x-ray or other documentation.

Specialized Licenses or training:

Successful completion of Excellent Foundations.
Maintains 20 hours of Annual Training through Relias or other appropriate sources.
Maintains at least minimum training for licensure.
Attends all assigned training specific to job assignment.

Physical Requirements:

The physical requirements described here are representative of those that must be met by an employee to perform the essential functions of this job successfully.  Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing the duties of this job, the employee is regularly required to stand, walk, talk, hear, and smell.  The employee frequently is required to sit; use hands to finger, handle, or feel; reach with hands and arms; and stoop, kneel, crouch, and climb stairs.  The employee is occasionally required to climb, balance or run.  Specific vision abilities required by this job include close vision, distance vision, and peripheral vision. 
Disclaimer:
This job description is not all-inclusive.  Other duties and responsibilities may be added as necessary.
 
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