General Statement of Duties:
The incumbent will be responsible for systematic review of assigned Board services’ medical/clinical records and related materials in order to objectively monitor and evaluate the provision and documentation of client services in conformance with various payer and regulatory standards.
As back-up to the QI Specialist, the incumbent will occasionally provide administrative supportive and coordination associated with the agency’s efforts to ensure that reporting and documentation Code requirements for Mandatory Outpatient Treatment (MOT) are followed, working closely with service providers involved in the process. Incumbent will also provide administrative support and coordination associated with reporting and documentation of NGRI cases.
The position assists with human rights and critical incident reporting when directed.
The position is non-exempt under the Administrative Provision of Fair Labor Standards Act.
The agency’s Compliance Manager supervises this position.
Distinguishing Features of Work:
The incumbent performs under minimal day-to day supervision a range of technical responsibilities requiring independent judgment, the exercise of a high level of discretion, and the use and application of quality improvement utilization review and information system techniques. The incumbent will possess the ability to comprehend and apply regulatory and policy requirements necessary to meet medical / clinical record keeping standards. The incumbent must possess excellent verbal and written skills and be able to organize and prioritize time sensitive tasks. The incumbent works in close collaboration with the Quality Improvement Specialist and Compliance manager to ensure consistent review and training practices and work distribution.
Major Duties and Responsibilities:
- Performs independent reviews of medical / clinical records including:
- Application of sampling and systematic reviews of electronic medical/ clinical records
- Reviews and analyzes medical/ clinical records to evaluate the provision and documentation of client services
- According to critical standards defined by payers regulations (i.e. Medicaid, Medicare, other 3rd party insurers, etc)
- For conformity with DBHDS Licensure requirements
- Systematic use of report formats for presenting feedback and problem identification to clinical staff, and presenting summary information to supervisors and directors
- Provide technical assistance and support to Board staff
- Assist with training activities designed to orient new staff and existing staff to new policies and procedures
- Assist in the development of forms, implementation of new procedures and related quality improvement activities
- As directed, can provide administrative support related to MOT activities:
working closely with clinical staff and community contacts involved in the process
- Works with the agency Emergency Services Supervisor and Compliance Manager to meet performance measures outlined in the State Performance Contract;
- Works collaboratively as an integral part of the MHLR Team providing administrative support and fulfilling other related duties as identified by the Team;
- Maintains a thorough understanding of state data reporting and outcome measures, providing
analysis and follow up as applicable to QI responsibilities and Step-VA mandated services;
- Maintains all records and documentation in accordance with Board Policies and
procedures to meet confidentiality requirements;
- Effective use of available technology, including computers, e-mail, and voice
mail in order to enhance customer service;
- Maintains effective relationships with co-workers and community contacts based on
courtesy, compassion, and respect;
- Performs duties in accordance with CSB policies and procedures, and performs other
duties as assigned
- Collaborates with QI Specialist for consistent review and training practices and work distribution.
Required Knowledge, Skills and Abilities:
Knowledge of behavioral or general health practices in Virginia, including associated record keeping and documentation, and outcome measurement principles and techniques.
Knowledge of quality improvement activities, accepted medical records standards, and utilization review techniques. Ability to understand, assess and evaluate compliance of medical/ clinical records against complex legal, regulatory and policy mandates and material.
Minimum Education and Experience:
Graduation from an accredited college or university with a bachelor degree in human services, public administration or a related area; two years experience working with behavioral healthcare, or, any equivalent combination of experience and training which provides the required knowledge, skills and abilities.
Equipment: Telephone, computer, designated software, fax, copier.
Work Environment: Office setting with routine office lighting levels, temperature ranges, air quality, ventilation, and noise levels.
Work Location: 1241 North Main Street, Harrisonburg, Virginia.
Work Hazards: Minimal hazards associated with general day-to-day behavioral healthcare operations; occasional hazards associated with problem behaviors.
Work Schedule: Part-time, Monday through Friday, regular office hours. Schedule is set and may be adjusted by the Compliance Manager in consideration of factors that will maximize the effectiveness of this position. If scheduled, some evening, weekend, or additional hours may be required on occasion to perform job requirements.