Compliance/QA Specialist I

Job Summary:

The Compliance/QA Specialist I performs various tasks that support the Compliance & Quality Assurance Department goals, objectives and functions to effectively prevent and detect violation of laws, regulations, policies or requirements. 

Supervisory Responsibilities:  None

Duties/Responsibilities:

• Perform routine and assigned audits, monitoring reviews and data collection using approved audit and monitoring instruments. 
• Conduct demographic data entry (CalOMS Admission and Discharge) and/or corrections across behavioral health sites.
• Assist in the collection of charts and/or data for quarterly Drug Medi-Cal Utilization Review and other Utilization Review meetings and participates in meetings as assigned.
• Conduct behavioral health quality assurance chart audits.
• Perform behavioral health billing reconciliation tasks.
• Perform routine compliance activities, such as SBAT monitoring, exclusions screening, etc. in support of department goals.
• Maintain organized physical and electronic files and documentation of activities.
• Attend committee meetings, prepare meeting summaries as assigned.
• Other duties as may be assigned.

Required Skills/Abilities:

• Strong attention to detail.
• Reliability in attendance and assignments.
• Adherence to tight deadlines and ability to multi-task.
• Ability to critically think through problems and tasks, and conduct research to identify solutions and/or support decisions
• Ability to learn computer software programs (e.g. electronic health record systems, external portals, etc.) in order to perform job duties within 3 months of hire
• Strong display of agengy values:  Compassion; Dedication; Integrity; Diversity.
• Basic knowledge of health care and social service systems.  Knowledge of behavioral health documentation.
• Self-motivated; ability to work independently and with a team.
• Compliance with applicable federal, state, contract and agency regulations, policies and procedures regarding the privacy, confidentiality and release of patient and business information.
• Adherence to professional and ethical standards of conduct, and health and safety standards.
• Ability to display respect for cultural and lifestyle diversities of clients and staff.

Education and Experience:

• Minimum 5 years’ experience in behavioral health care field, preferably substance abuse.

• Bachelor’s Degree in a health or human/social service or related field, or equivalent combination of education and experience. 
• Experience and proficiency with MS Office Suite, especially WORD and Excel

Physical Requirements: Following are the qualifications required to perform the essential functions of this position.  Qualifications may be subject to modification based on the Americans with Disabilities Act.

• Vision, hearing, manual dexterity and eye-hand coordination must be adequate for performance of job duties. 

• Able to sit at desk, use keyboard, write and physically perform other job duties.  Prolonged periods of sitting at a desk and working on a computer.
• Able to move about the facility.

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements which may be inherent in the position.