Quality Assurance Specialist National Council on Alcoholism
Overview
Quality Assurance Specialist at National Council on Alcoholism leads integrity accuracy compliance and timely billing of Drug Medi-Cal substance use disorder services. Reports to Sr. Director of Clinical Services and Program Innovation. Owns quality control between clinical service delivery documentation billing and program operations.
What You'll Do11
- 1Review DMC services prior to billing to verify complete compliant documentation and validate service details against clinical records
- 2Identify duplicate services overlapping services unsupported units missing documentation incorrect service codes and other billing discrepancies
- 3Conduct pre-billing reviews communicate corrections to clinical administrative staff track resolution of identified issues and support timely claims submission
- 4Perform routine reviews of patient records assessing completeness accuracy timeliness and regulatory compliance of assessments problem lists treatment plans progress notes group documentation discharge records and care coordination
- 5Maintain working knowledge of SAPC DHCS and Medi-Cal requirements monitor regulatory changes and assist leadership with operational implementation
- 6Conduct internal audits compare billed services against supporting documentation identify trends and escalate unsupported inaccurate duplicate or falsified billing to leadership
- 7Monitor service utilization and documentation patterns review productivity and billing reports for unusual patterns assist leadership analysis of volume and documentation completion
- 8Track quality assurance findings develop reports recommend workflow improvements and participate in performance improvement activities
- 9Provide technical assistance to clinical and administrative staff regarding DMC documentation and billing coordinate corrections and follow up on outstanding billing issues
- 10Support preparation for external audits assist with corrective action plans and respond to audit findings
- 11Collaborate with supervisors to address recurring training needs and promote documentation accuracy culture
Requirements13
- 1High school diploma or equivalent minimum two years experience involving Drug Medi-Cal billing quality assurance clinical documentation review or related DMC administrative functions
- 2Direct experience with DMC substance use disorder billing within Los Angeles County strongly required
- 3Working knowledge of Los Angeles County Department of Public Health Substance Abuse Prevention and Control SAPC requirements and billing processes
- 4Experience with Sage-PCNX or comparable Los Angeles County DMC billing and service-entry workflows
- 5Knowledge of Medi-Cal/DMC documentation and billing requirements ability to review clinical documentation and determine support for billed services
- 6Strong attention to detail ability to identify discrepancies between documentation service data and billing records
- 7Ability to maintain confidentiality handle sensitive patient billing compliance and personnel information strong organizational analytical written and verbal communication skills
- 8Proficiency with Microsoft Office especially Excel Outlook and Word ability to work within electronic health record and billing systems
- 9Associate or bachelor's degree in healthcare administration behavioral health business administration health information management or related field
- 10Three or more years of direct experience with Los Angeles County SAPC/DMC programs experience conducting clinical chart audits billing audits or compliance reviews
- 11Familiarity with CalAIM documentation and reimbursement requirements experience with outpatient substance use disorder treatment programs
- 12Current or previous registration certification as a SUD counselor through DHCS-recognized organization preferred bilingual Spanish English
- 13Must pass DOJ and FBI background clearance valid California driver's license reliable transportation TB clearance driving record acceptable for agency insurance fire safety training first aid and CPR certification
Salary Insight
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