Quality Assurance Specialist

Function:

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:

Experience:

Specific Skills and

requirements:

Specialized Licenses or training:

Physical Requirements: