Quality Assurance Specialist

Job Title: Quality Assurance Specialist I 

Department: Compliance & Quality Assurance

Reports To: Director of Compliance & Quality Assurance

Hours: Full Time, 40 hours (M-F; Occasional evening and weekend work required)

FLSA Status: Non-Exempt, 

Employment Type: Contract to Hire

Field-Based: No.

About Us: Counseling4Kids (C4K) has been serving children and families for over 20 years. We were founded with the goal of providing mental health services to children in Los Angeles County’s foster care system. We responded to the immense need for mental health services to help these children heal from the abuse and neglect they had suffered. Initially, the C4K treatment program had eight therapists providing services for 25 clients. Our range of services include: individual therapy, family therapy, psychological evaluation, medication support, case management and referral to community resources. C4K is currently in a transformation state as we are looking to build a large team of highly skilled, licensed therapists providing assessments and weekly therapy to children and youth. Our goal is to create an agency that provides quality services to the community. You can be a part of this vision by joining our team.  

Why Work for Counseling4Kids? Our success depends on attracting and retaining a diverse range of people who are committed to excellence, making a positive impact in the lives of children and families, and the overall promotion of healing. C4K strives to foster a community of respect, teamwork, growth and fun. In addition, we are able to offer our talented staff several benefits including but not limited to: Fully paid employee medical, dental and vision; Supplemental Insurance; Retirement plan matching up to 5%; and generous paid time off. If that weren’t enough we also offer several perks such as; time off to volunteer; access to discounted fun; lunch and learn sessions; fun team-building exercises; community networking opportunities; mileage and expense reimbursements; and CEUs, compliance and professional development access via Relias training portal and other community resources.

About the Role:This is for a contracted employee role, with an expected duration of six (months). At the end of the contracted period of employment, job performance, attendance, attitude and overall interest in the job will be assessed in a performance evaluation to determine if an offer of full-time at will employment will be made, if the contract period will be extended, or if the contract will be ended without further offer of employment. 

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:

• Uphold the mission and core values of Counseling4Kids.
• Participate in the on-boarding and orienting of direct care providers administrative tasks.
• Participate in Quality Assurance activities including chart reviews, documentation training, tracking/monitoring of contract performance, and providing formal trainings to licensed clinicians under the guidance/direction of the Director of Quality Assurance.
• 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.
• Implementation of departmental Quality Improvement and Utilization Review efforts.
  
• 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.
• Active oversight of all transfer procedures (same-office and inter-office transfer) of clients.
• 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 weekly QA Committee meetings; writing and tracking QA meeting minutes.
• 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 Problem List 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 and Semi-Annual paperwork reports.
• Notice of Adverse Benefit Determination (NOABD) - Responsible for sending NOA-Es to Patient Rights and Consumers when consumers’ intake appointments are not scheduled within required parameters.
• Organize completed Request for Change of Provider forms and Notice of Adverse Benefit Determination (NOABD) notifications.
• 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
• Complete all program changes in EXYM (i.e. changing funding source, program type, EBP, etc.)
• Reviewing, tracking and filing of satisfaction surveys.
• Completion of QA projects assigned
• Participate in cross-training for administrative duties and functions and provide administrative coverage and support when necessary.
• 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.

Note: In the event that the Agency requests the regular usage of bilingual skills, the passing score of 70% on a proficiency test is required to receive a monthly bilingual stipend; per the Agency’s Bilingual Stipend Policy.

Supervisor Responsibility

This position has no supervisory responsibilities.

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

EEO Statement: 

 Counseling4Kids provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Counseling4Kids complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. 

Counseling4Kids expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Counseling4Kids’ employees to perform their job duties may result in discipline up to and including discharge.