Clinical Review Specialist

Top reasons to work for SMA Healthcare:

• Career growth and advancement potential
• Great benefits such as: Health, Dental, Vision, Life, & Disability Insurance
• Tuition Reimbursement
• Paid Personal Leave (up to 25 days after 3 years of service)
• 403b Retirement Plan (matches one to one of employee contribution for the first 3%, then a 50% match on the next 6% of employee contribution)

Essential Job Functions: 

• Complete audits to assure services provided are current, accurate, and meet all documentation/compliance requirements in accordance with CARF, Medicaid, Department of Children & Families (DCF)/LSF, HIPAA, and SMA standards.
• Ensure that documentation in medical records adequately supports the service code that was billed. 
• Complete audits as assigned each month.
• Identify and report trends and/or deficiencies to Clinical Compliance Manager.
• Writes legible, informative, and understandable notices of non-compliance issues identified through reviews of client records.
• Gather and prepare required documentation for external audits, including desk audits. 
• Stay updated with CARF, HIPAA, Medicaid, Department of Children & Families/LSF, and SMA standards changes.
• Assist the Clinical Compliance Manager and performs related work as required or assigned.
• Performs miscellaneous job-related duties as assigned.

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education and/or Experience:  A minimum of a Bachelor's Degree, preferably with a concentration in psychology, social work, mental health counseling, or human service-related field.  Experience working in behavioral health preferred.  Experience with Medicaid, DCF/LSF auditing and CARF accreditation is preferred.

Knowledge/Skills/and Abilities: 

• Knowledge in behavioral health, knowledge of current practices and documentation requirements regarding the care and treatment of the population served.
• Knowledgeable of CARF, HIPAA, Medicaid, Department of Children & Families/LSF, and SMA standards and becomes familiar with changes.
• Knowledge of administrative and data systems, procedures and processes for improving program effectiveness and efficiency.
• Knowledge of data collection, compilation, and reporting. 
• Ability to prepare clear and concise reports.
• Knowledge of state regulatory policies and accreditation standards pertaining to mental health service delivery.
• Ability to train, consult, and present improvement recommendations to staff, committees, and others.
• Ability to evaluate and analyze systems problems and make recommendations for corrective actions. 
• Ability to complete work under strict timelines, while maintaining flexibility to assist with emergent issues/concerns;
• Ability to establish and maintain effective working relationships with co-workers, medical and clinical professionals, and the general public. 

Necessary Special Requirements: Possession of a valid Florida driver's license, acceptable driving record, and proof of personal automobile insurance if required to drive an SMA vehicle and/or use a personal vehicle for SMA business. Complete State of Florida mandatory background screening prior to start of employment.  Complete SMA required training during the first six (6) months of employment and updated if required.

Physical: Mobility and ability to bend and reach during an 8?12-hour day. Able to lift a minimum of 10 pounds. Visual and auditory acuity sufficient to evaluate, intervene, treat, and record client health care needs. Fine motor skills for legible and accurate charting, daily correspondence, and presentation, either manually or orally. Routine 8-hour shifts.  Work endurance ability to work 8?12-hour shifts with a meal break, as possible. Extra hours may be required. Work assignment locations may vary.

Application:This class specification is intended to identify the class and illustrate the kinds of duties that may be assigned to its incumbents.  It should not be interpreted as describing all the duties whose performance may ever be required of such an employee or be used to limit the nature and extent of assignments such individuals may be given.