SpectraCare Health Systems, Inc. · 1 month ago
Quality Assurance (QA) Reviewer II
Dothan, AL
Full-time
Onsite
Entry, Mid Level
2+ years expSpectraCare Health Systems, Inc. is seeking a Quality Assurance (QA) Reviewer II to work at their Administration Office in Dothan, AL. The role involves maintaining compliance files, performing routine reviews, conducting audits, and reporting findings to the Chief Compliance Officer.
CommunitiesHealth CareMedicalMental HealthSocial Assistance
Responsibilities
Maintains files on:
Clinical policies and procedures for Mentally Ill, Developmental Disabilities and Substance Abuse Divisions
Medicaid regulations and requirements
Medicare regulations and requirements
Department of Mental Health regulations and requirements
Any other relevant funding or compliance agency regulations and requirements
Performs routine reviews checking for compliance to Department of Mental Health, Medicaid, Medicare and applicable billing requirements for:
New employees within six (6) months of hire
Terminated, resigning or transferring therapists
Minimum of 10 % of clinician’s caseload annually (preferably 3% - 5% quarterly)
Income verification and reimbursement source versus printout
Performs audits on or by:
Medicaid review of charts
Medicare/Other Insurance
Self Pay Status
Clinician
Clinical aspects of services
Billing
Income verification and reimbursement source versus printout
Receipt sequence report
Follows up on deficiencies and reports trends/findings to Chief Compliance Officer
Investigates Special Incidents as needed
Other Duties As Assigned By Chief Compliance Officer
Regular attendance with timely arrival and departure according to scheduled hours
Qualification
Required
Master's degree or above from an accredited college or university in psychology, social work, counseling, or other behavioral health area with requisite course work equivalent to that of a degree in counseling, psychology, or social work
Minimum two (2) years' clinical experience required
Personal computer background with familiarity and training in word processing, spreadsheets and data base management
Valid driver's license and good MVR
Must meet insurability requirements to drive a system vehicle (21 years of age)
Preferred
At least two (2) years' experience operating an EMR system
Four (4) or more year's clinical experience in a mental health, business, computer science or related field
Strong business background preferred
Benefits
Blue Cross Blue Shield of Alabama Health and Dental Insurance
Alabama State Retirement
Paid Time Off - Annual, Sick, Personal and Comp
OnShift Wallet through Payactiv
PTO Buyback Program
Company paid life insurance
AD&D and dependent life insurance
10 Paid Holidays
Public Service Loan Forgiveness
Company
SpectraCare Health Systems, Inc.
Providing behavioral health services to Wiregrass families since 1968.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Melissa Kirkland
Chief Executive Officer
Ashley Cole
Chief Information Officer
Company data provided by crunchbase