Compliance Specialist

Richmond Behavioral Health is seeking a highly skilled and qualified Quality Compliance Specialistto join our Quality and Standards Division. The selected individual will perform difficult skilled administrative support work conducting audits of client electronic health records personnel records and other systems for compliance with Federal and State regulations. Ensure billable services were adequately documented to substantiate payment for services rendered minimizing risk of retraction. Reviewing records to ensure clinical soundness and best practices are being utilized to ensure clients needs are met. Ensure compliance with other federal and state agency regulations including DBHDS DMAS MCOs HIPPA and/or other accrediting body. Providing support to Authority wide improvement strategies to include risk management plan. Providing education and trainings to staff regarding compliance regulations best practice standards of person centered planning clinical documentation clinical risk assessment and related work as needed or assigned. Work is performed under the limited supervision of the Program Supervisor II.

Essential Functions

Ensures compliance with incident reporting agency wide by reviewing logging and reporting per agency DBHDS and MCO requirements to include RCAs.

Conducts Human Rights investigations as a result of incident reports and complaints

Reviews monthly and quarterly data to determine if agency is meeting thresholds requiring enhanced RCAs

Perform look behind audits based on CAP data to improve quality outcomes

Reviews records for ROIs or audits as needed

Performs clinical and administrative audits as needed throughout the Authority to ensure compliance with Licensure (DBHDS) Department of Medical Assistance Services (DMAS) Managed Care Organizations (MCOs) Medicare and Authority standards.

Summarizes review findings for submission to division leadership

Develops strategies/reports to monitor compliance and changes with various regulations/regulatory bodies.

Provides education/training as needed to address findings from quality reviews to enhance best practices clinical soundness effective interventions regulatory compliance and person-centered components per regulatory bodies

Attends clinical staffings provides support guidance and assistance in developing plans for corrective action.

Conducts HIPAA walk-thru inspections for the entire Authority two times each calendar year and summarizes findings to report to executive management.

Identifies areas for Authority-wide improvement strategies.

Provides on call coverage for incident reporting at least monthly on weekends/holidays

Assists with special projects as needed and assigned

Required Experience:

IC