QI Compliance Manager

POSITION SUMMARY

Responsible for enhancing the quality of services provided, by maintaining an agency wide QI system to meet regulatory and compliance requirements; thereby minimizing risk and improving service delivery. Assumes primary responsibility for the daily functions and operations of the QI department which includes oversight of the positions responsible for outcomes, credentialing, accreditation, utilization management and auditing/monitoring.

Essential Duties and Responsibilities:

The essential functions include, but are not limited to the following:

· Provides direct supervision of the Outcomes Specialist, Compliance Specialist, QI Coordinator, Utilization Management Coordinator, and Auditingpositions to include regular supervision, training, assignment of work, policy/procedure compliance, and performance reviews.

· Provides overall oversight of the documentation/billing corrections ticket system.

· Develops department goals. Participates in the development of budgeting and has direct responsibility for adhering to those goals.

· Develops and provides training to other departments as needed related to documentation and billing requirements.

· Responsible for coordinating internal and contract provider audits for clinical programs in conjunction with department managers. Communicates with managers to coordinate and prioritize auditing and compliance needs.

· Coordinates with HIM department to ensure that chart requests from payors are completed accurately and timely by reviewing documentation prior to it being sent.

· Maintains full knowledge of agency policies and procedures, service codes and definitions, and regulatory guidelines and directives. Serves as primary point of contact for employees and contractors regarding documentation and regulatory requirements.

· Prepares for and coordinates Department of Mental Health audits, Mental Health Tax Levy audits, CCCSF audits, and CARF surveys.

· Follows up on internal audits and regulatory inspection reports and action plans to assure the timely completion of corrective actions.

· Assists in the investigation of regulatory concerns as directed by the CQCO.

· Coordinates with the Billing Team as needed to investigate denials due to diagnosis code, billing code/modifier, and provider not eligible.

· Serves as member of Quality Improvement, Avatar, and ComplianceCommittees.

· Maintains knowledge of agency technology programs and/or systems needed to do the job and uses them effectively.

· Other duties and/or responsibilities that may be assigned.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)

· Masters Degree required

· Clinically Licensed or Provisionally Licensed preferred

Experience required

· 3+ years of position related experience required.

· Direct supervision of staff preferred.

Required Knowledge:

· Basic Knowledge of Microsoft Office Suite (Word, Excel, Power Point)

· Knowledge of CARF and CCBHC Standards, Missouri Department of Mental Health regulations, and Missouri Medicaid billing rules preferred.

· Knowledge of value-based measures and reporting

· Knowledge of credentialing and privileging requirements and processes

· Knowledge of data collection, analysis, statistics, and data presentation

· Experience with Electronic Health Records

· Crystal Report writing skills and experience a plus

Skills/Abilities

· Excellent communication skills, both written and verbal.

· Strong ability to multi-task with a high level of accuracy and timeliness in project output.

· Ability to present complex information in an understandable manner.

· Ability to maintain a high level of client confidentiality.

· Excellent critical thinking and problem-solving skills.

· Strong interpersonal, communication and collaboration skills.

· Ability to work collaboratively with staff at all levels.

· Ability to research and understand billing and documentation requirements.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or listen. The employee is regularly required to drive to local destinations within the catchment area. The employee frequently is required to use hand or finders, handle or feel objects, tools or controls. The employee is occasionally required to stand, walk, sit and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by the position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.