JOB SUMMARY: The Quality Assurance Specialist assists the Agency in maintaining compliance with the Los Angeles County Department of Mental Health’s (DMH), local County and State requirements for Mental Health Treatment. This role is instrumental in implementing quality improvements, chart reviews, tracking and reporting to ensure that all components from the acceptance of a client case to their discharge occur.

ESSENTIAL FUNCTIONS:

• • Complete administrative reviews of clinical records and provide regular reports on the accuracy of admissions dates, discharge dates, face sheets, financial forms, regularity of chart notations, and any other technicalities reviewed by the Department of Mental Health.
• - 3-month (Mini-UR already in place)
• - 5-month period (ensure that 3-month follow up has been completed)
• - 12-month period
• • Assess and analyze deficiencies in clinical records and identify trends in deficiencies.
• • Manage scanning process/procedures of documents. Ensure quality control of scanned clinical records through active review of scanned documents for quality, readability, legibility and accuracy.
• • Organize, sort and re-distribute charts in the Records Room annually. Ensure that clinical records are maintained in an orderly environment and secured in locked file cabinets. Monitor the signing in/out of clinical records.
• • Active oversight of all transfer procedures (same-office and inter-office transfer) of client files.
• • Process all requests for Client Information and Disclosures.
• • Make monthly Service Verification Calls to clients/caregivers to verify field-based services. Process Field Based Service Verification forms for the purpose of oversight and monitoring of field-based service delivery.
• • Process and track all out-of-county Medi-Cal clients as well as completing the Service Authorization Requests.
• • Assist Managers with Contract Compliance:
• - Track PEI group attendance and inform managers of non-compliance.
• • Attend bi-weekly QA Committee meetings; writing and tracking QA meeting minutes.
• • Obtain annual authorizations to release information from attorney for DCFS cases.
• • Create weekly/monthly reports to maintain QA Documentation standards. Investigate the cause of deficiencies and collaborate with Compliance & QA Director to resolve issues:
• - Run Diagnosis (EXYM/IBHIS) reports.
• - Run Addition of Goals/Signature requirement reports.

- Maintain correct client information in the IBHIS, EXYM and Medi-Cal systems, including ensuring that all systems contain identical client/case information.

- Ensure that all Psychiatrist Goals are completed on EXYM.

- Run Annual paperwork reports.

• • Utilization Review:
• - Mini-Utilization Reviews
• - Fully review all charts on the Mini-UR list each month.
• - Inform providers and managers of corrections that need to be made to Mini-URs.
• - Track corrections and completion of Chart Essentials forms.
• - Prepare Mid-Cycle Review packets for managers and track completion.
• - Track all Big Utilization Reviews and enter the findings into EXYM.

• • Notice of Action
• - Responsible for sending NOA-Es to Patient Rights and Consumers when consumers’ intake appointments are not scheduled within required parameters.

• • Financial Folders - Tracking and filing annual PFIs
• - Maintaining Financial Folders
• - Running monthly UMDAP reports and notifying providers if annual financial cycle is different than coordination cycle.
• - Ensuring that copies of Medi-Cal cards are obtained

1. • Complete all program changes in EXYM (i.e. changing funding source, program type, EBP, etc.)
2. • Reviewing, tracking and filing of satisfaction surveys.
3. • Completion of QA projects assigned (i.e. scanning project)
4. • Participate in cross-training for administrative duties and functions and provide administrative coverage and support when necessary.
5. • Other duties as assigned.

Other Duties

• • Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Competencies

• • Customer Service
• • Collaboration
• • Thoroughness
• • Communication

• • Flexibility
• • Leadership
• • Ethics

MINIMUM QUALIFICATIONS:

- Experience with of the LA County DMH policies and procedures

- Experience with the Integrated System, IBHIS, Medi-Cal eligibility and billing

- Knowledge of Electronic Health Records, Microsoft Word, and Excel

- BA in psychology, social work or related field

OR one of the following equivalents:

- AA degree in related field and minimum 2 years relevant work experience

- 4 years related work experience in a mental health agency

- Bilingual English/Spanish preferred

Special Conditions:

NOTE: The first ninety (90) days of employment is an introductory period. At the end of the first ninety (90) days, job performance, attendance, attitude and overall interest in the job will be assessed in a performance evaluation.

Employees who fail to demonstrate the expected commitment, performance and attitude may be terminated at any time during the introductory period. However, completion of the introductory period does not change or alter the “at-will” employment status. Employees continue to have the right to terminate their employment at any time, with or without cause or notice, and the Agency has the same right. The company, in its sole discretion, may change the job duties, responsibilities and assignments of any position, at any time.

Physical Demands:

Must be able to remain in a stationary (stand/sit) position at least 50% of the time. This person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer. Frequently communicates with staff, clients, families and other community organizations and must be able to exchange accurate information. Regularly exposed to outdoor weather conditions when out in the community.