Quality Assurance Specialist

Brief Description

The Quality Assurance Specialist is responsible for ensuring that services meet the established standards of quality, including reliability, and performance. This role involves designing and implementing testing procedures, analyzing results, and providing recommendations for improvement. The specialist collaborates closely with other departments to ensure compliance with contract requirements and company standards, aiming to enhance overall customer satisfaction and operational efficiency.

Qualifications

• High school diploma or GED required.
• Two years of data entry/clerical or experience in a mental health setting required.
• Demonstrates exceptional public relations skills, along with strong proficiency in phone communication and interpersonal interactions
• Demonstrated ability to effectively prioritize tasks and consistently meet deadlines in a professional setting.
• Proficient in Microsoft Office Suite, Outlook, Excel, Word.
• A valid California driver’s license is required of staff who have regular driving duties and the driving record must meet the requirements of their position and be approved by the agency’s insurance company.
  
  

Essential Job Functions

• Maintain a high level of accuracy in data entry tasks, including extensive keyboarding and numeric input.
• Use personal vehicle to transport agency records and materials, ensuring safe and secure handling.
• Efficiently juggle multiple tasks, monitor progress on ongoing work, and meet deadlines in a dynamic environment.
• Uphold strict confidentiality standards concerning agency operations, client information, and employee data.
• Exhibit strong problem-solving skills by effectively managing and resolving unexpected challenges and situations.
  
  

Responsibilities

• General data entry input for County billing System including, admission/ discharge/ transfers, Medi-cal verification, data input for authorization periods, maintaining financial information, managing authorizations, and managing and processing appropriate NOA’s.
• Data input for Program Incident Reports, prepare monthly reports for Board Meetings.
• Compile Performance Measurement Outcome Data per contractual, Joint Commission, and agency requirements.
• Coordinates and monitors the agency’s internal Peer Review process.
• Effectively communicates with colleagues, supervisors, coordinators, and directors daily on contract compliance efficiency.
• Create and review client record format, client chart contents, required forms and documentation standards for client records.
• Assists the QA Director in the collection, tabulation and organization of data to be included in presentations and program reports.
• Ability to learn and navigate through private health insurance clearinghouse software.
• Ability to learn and navigate through private health insurance billing including coverage verification, billing services, processing claims and denials.
• Help maintain agency procedure manuals.
• Provide expertise in EHR systems.
• Ability to work with staff to troubleshoot issues within the EHR system and provide resolutions and training.
• Manage all stages of the revenue cycle, including claim creation, denial management, and payment position, to ensure maximum reimbursement.
• Monitor claim progression daily, manage reports, and submit monthly updates on billing activities to the Director.
• Work closely with other departments and the Finance Team to analyze information, resolve billing issues, and ensure accurate financial reporting.
• Responsible for preventing and controlling infection.
• Responsible for maintaining a culture of quality and safety.
• Effectively use de-escalation skills and techniques for crisis prevention.
• Properly administer the C-SSRS to help prevent suicide.
  
  

Other

• Attend all required meetings and trainings.
• Report any suspected child or dependent adult/elder abuse or neglect immediately to direct supervisor or utilize the chain of command if supervisor is unavailable.
• Report any client imminent danger to self or to others or gravely disabled immediately to direct supervisor or utilize the chain of command if supervisor is unavailable.
• Other duties as assigned.
  
  

Summary

We are a nonprofit organization with a mission to strengthen families and communities by transforming lives! We are currently recruiting for a Quality Assurance Specialist for our Quality Assurance team, who is ready to make a difference in the lives of others!

Why Sierra Vista?

Our supportive, caring environment extends not only to our clients and families, but to our valued staff as well. Employees from a number of disciplines work together in a collaborative, stimulating environment that is a model for quality care.

Sierra Vista Child & Family Services Offers

• Health Insurance Coverage - SVCFS offers a comprehensive health benefits package which includes medical dental vision coverage, and an employer paid life insurance policy.
• 2 weeks of vacation, 11 paid holidays, 12 sick days upon accrual.
• Employee Assistance Plan unlimited access to professional consultants for money management, family counseling, legal advice and many other areas.
• Optional 403(b) retirement plan with employer matching.
• Clinical Supervision for state licensure.
• Opportunities for growth and professional development.
• Non-Profit Student Loan Forgiveness.
• Salary Increases each year.
• Supportive/collaborative work environment.
• Discounts are available to employees for gym memberships, with cellphone plan providers and other discounted perks.