Quality and Compliance Specialist

Position Summary:The Quality & Compliance Specialist supports the organization’s quality assurance and compliance efforts through ongoing auditing and monitoring of patient records. This position is responsible for ensuring documentation is complete, accurate, timely, and compliant with applicable state licensing requirements, accreditation standards, organizational policies, and insurance/payer contractual requirements. This position also serves as the primary point of contact for chart-related quality assurance and compliance matters and works collaboratively with the interdisciplinary team to identify, communicate, correct, and monitor documentation deficiencies.

Essential Duties and Responsibilities:To perform this job successfully, an individual must be able to perform the following satisfactorily; other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Maintain working knowledge of The Joint Commission, ASAM, Florida Department of Children and Families (DCF), and other applicable regulatory and accreditation standards, and apply these requirements when conducting chart audits, monitoring compliance, and identifying documentation deficiencies.
• Conduct routine and targeted audits of patient records for completeness, accuracy, timeliness, and compliance.
• Monitor documentation for compliance with applicable state licensing requirements, accreditation standards, organizational policies and procedures, and insurance/payer contractual requirements.
• Identify missing, incomplete, inconsistent, or non-compliant documentation and communicate findings to the appropriate team members.
• Work collaboratively with Clinical, Medical, Utilization Review, Billing, and other interdisciplinary team members to facilitate timely correction of identified deficiencies.
• Notify appropriate departments and leadership of audit findings or discrepancies that may impact patient care, medical necessity, authorization, billing, reimbursement, or regulatory compliance.
• Review, track, and follow up on chart-related corrective actions resulting from internal audits, payer audits, Corrective Action Plans (CAPs), regulatory surveys, accreditation surveys, or other external reviews.
• Assist with chart preparation, documentation review, and corrective actions associated with payer, regulatory, accreditation, and internal audits or surveys.
• Monitor completion of required corrections and maintain appropriate documentation of audit findings, corrective actions, and follow-up.
• Identify recurring documentation deficiencies, compliance trends, and potential areas of risk and communicate findings to leadership.
• Serve as the primary point person for chart-related quality assurance, compliance, and audit readiness.
• Perform other quality assurance and compliance duties as assigned.

Qualifications:

• Experience in compliance, quality assurance, healthcare, or a health and human services-related field.
• Experience conducting audits, chart reviews, quality assurance reviews, or other compliance monitoring activities. 
• Strong attention to detail with the ability to identify documentation deficiencies, discrepancies,and areas of noncompliance.
• Strong organizational skills with the ability to track findings, required corrections, and follow-up through completion.
• Strong written and verbal communication skills.
• Ability to communicate audit findings, deficiencies, and compliance concerns professionally, clearly, and collaboratively.
• Ability to work effectively with members of an interdisciplinary team.
• Ability to maintain confidentiality and appropriately safeguard patient and protected health information.

Preferred Qualifications:

• Experience in behavioral health and/or substance use disorder treatment.
• Knowledge of The Joint Commission, Florida Department of Children and Families (DCF), and ASAM standards and requirements.
• Familiarity with insurance/payer contracts, documentation requirements, and payer audits.
• Familiarity with regulatory and accreditation surveys and corrective action processes.