Behavioral Health Quality Assurance Specialist I

Full-time, Days

Monday-Friday

80 hrs/2 weeks

 

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.

 

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.

WellSpan Health’s vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region’s largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.