Behavioral Health Quality Assurance Specialist I - Days

Full-time, Days

General Summary

Conducts chart audits, uses data for healthcare quality measures to review for trends and gaps related to quality documentation to ensure compliance with regulatory and payor agencies. Elevates and communicates gaps and opportunities through established channels.

Duties and Responsibilities

Remote Work Capable

Essential Functions:

• Supports the organization's commitment to comply with all federal, state, and local standards, with an emphasis on Mental Health and Substance Abuse regulatory agency requirements.
• Demonstrates knowledge of regulatory and payor guidelines as they pertain to documentation requirements, quality review requirements, and policies and procedures.
• Performs monthly audits of Behavioral Health medical records to ensure compliance with regulatory and payor agencies.
• Enters and tracks data collected from monthly audits into an electronic format for reporting purposes and identification of compliance related trends.
• Identifies compliance documentation opportunities and provides consultation and education to clinicians, leadership and others.
• Maintains appropriate records, reports, and files as required for the department.
• Covers responsibilities for peers in their absence.

Common Expectations:

• Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
• Participates in educational programs and staff meetings required for the department.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
• Attends meetings as required.

Required for All Jobs:

• Performs other related duties as identified.
• WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity, and ethics. Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.
• WellSpan Health has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Physical Demands:

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Frequently
• Reaching - Rarely
• Talking - Frequently
• Hearing - Frequently
• Repetitive Motions - Occasionally
• Eye/Hand/Foot Coordination - Occasionally

Working Environment:

• Occupational Hazards - Occasionally

Qualifications

Minimum Education:

• High School Diploma or GED Required
• Associates Degree Preferred or
• Bachelors Degree Preferred

Work Experience:

• 2 years Working in Behavioral Health. Required or
• 2 years Working in a Quality Assurance role. Required

Knowledge, Skills, and Abilities:

• Excellent communication and interpersonal skills.
• Demonstrated basic to intermediate to advanced proficiency with Microsoft Office Suite/Excel.
• Detail Oriented.
• Critical thinking skills.