Quality Assurance Specialist

3 weeks ago


San Diego, United States CRF Behavioral Healthcare Full time

**Hours**:36 hours per week; Monday - Thursday, 9:00 am to 5:00 pm and Friday, 9:00 am to 1:00 pm.

**Hourly Pay Rate**:$37.38 to $40.06 per hour

**Education**: An Associate's degree (or higher) in Health Information Technology, Medical Billing, Quality Management or similar field strongly preferred

**Benefits**:

- 19 days of PTO and 12 paid holidays per year
- Free clinical supervision and CEUs
- Monthly contribution of $100 towards qualified student loan debt; access to Public Service Loan Forgiveness (PSLF) program for eligible individuals
- Choice of medical plans, with mínimal employee cost/expenses and excellent coverage
- Several dental plan options; vision benefits
- Company-paid life insurance and Long-Term Disability
- Tax-Free Flexible Spending for medical/dental/childcare expenses
- Generous retirement plan contributions
- Free Employee Assistance Plan
- Employee discount program, including pet insurance plans
- Opportunities for advancement and growth

**Program Overview**:
Our Quality Improvement Department responds to and tracks incidents, complaints, and reporting elements; evaluates medical records and billing; provides consultation and risk management analysis; provides clinical and documentation training; and develops/implements CRF policies and procedures and process improvements. A high level of confidentiality and discretion is required.

Located at our Central office in the Mission Bay area, we provide management support services for all of the mental health programs of Community Research Foundation and PERT, Inc. Our Central Office consists of Administration, Human Resources, Accounting, Information Technology, Real Estate and Facilities, Quality Improvement, and Research & Development.

**As a Quality Assurance Specialist / Billing Technician, you will**:

- Audit and evaluate medical records (to include progress notes and assessments) to ensure they are accurate, clinically appropriate, justify medical necessity for MediCal reimbursement, and in compliance with all State and County regulations.
- Review MediCal billing for accuracy and appropriateness for approximately 30 CRF programs.
- Run and analyze billing reports from the designated electronic health record to correct and prevent billing disallowance and errors.
- Serve as a MediCal billing expert for CRF program staff. Provide consultation, feedback, education, and training to program management and direct care staff regarding accurate and compliant billing and documentation practices.
- Develop corrective measures and plans to address any problematic documentation and billing.
- Make recommendations for disallowance and billing corrections as needed and oversee the correction process in conjunction with program staff and the County Mental Health Billing Unit.

**Additional Qualifications & Skills**
- 1-2 years of experience working in a Hospital or Outpatient Healthcare Billing Department, Quality Assurance Department, and/or Utilization Review Department required.
- Experience working in the field of mental health is strongly preferred (such as a hospital or outpatient clinic)
- Knowledge of high-quality billing and documentation practices in a Fee for Service model.
- Knowledge of MediCal requirements and Medical Necessity Criteria.
- Strong writing skills including attention to detail and editing.
- Ability to respond to, communicate, and consult effectively with management.
- Ability to pass criminal/background clearance

**We are an Equal Opportunity Employer**

Quality Assurance Specialist / Billing Technician



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