General Statement of Duties:
Responsible for management of the agency’s Compliance Department which encompasses oversight of payer and government entity regulations towards the goal of maximizing documentation quality, compliance, and revenue potential. Manages critical incident reporting systems and CSB planning processes related to regulatory compliance. Provides supervision to the agency Quality Improvement Specialist, Access Benefits Coordinator, Access Benefits and Compliance Technical Specialist, Credentialing Specialist, and Risk Management Specialist. Works closely with agency management, administrative, and clinical staff, and represents the agency in regional and state initiatives directed at regulatory compliance. This position is supervised by the Administrative Services Director.
Persons in this position are classified exempt under the Fair Labor Standards Act.
Distinguishing Features of Work:
Thorough understanding of payer regulations, compliance and quality improvement requirements that regulate, pay for/fund the public behavioral health and developmental services system including Medicaid and Managed Care Organizations (MCOs), the Department of Behavioral Health and Developmental Services (DBHSD) Licensing and Human Rights regulations and State Performance Contract. Direct understanding of clients and clinical services provided in the CSB system. Ability to identify, implement and monitor agency processes to meet requirements and identify issues and areas of noncompliance, recommending corrective action to Management. Effectively communicates with a variety of system stakeholders.
Major Duties and Responsibilities:
Supervises the systematic review of CSB electronic health records to assure compliance with licensure, Medicaid and other payers, CSB policy and other requirements
Ensures that agency policies and procedures conform to current Human Rights regulations and acts as the agency’s primary contact point for human rights complaints/issues
Oversees agency process for incident investigations and root cause analysis process
Supervises consumer critical incident reporting system (CHRIS) consistent with State licensing requirements
Supervises the training of new and existing staff in all areas of CSB operation overseen by Compliance Department
Oversees staff credentialing efforts to ensure compliance with State Board of Counseling and other entities that may impact licensing and payment for services
Monitors payer contracting and updates
Supervises the process for obtaining managed care authorizations in compliance with payer requirements
Serves as HIPAA Co-Privacy Officer for the CSB, focusing on confidentiality protections as relates to consumers, privacy notices, policies, complaints, etc.
Actively participates in regional, and state workgroups that address compliance and regulatory issues and changes, representing the agency’s needs and keeping staff apprised
Oversees the creation of forms and processes in the EHR to ensure regulatory compliance
Assists with developing and implementing Agency Quality Improvement Plan as required by the Performance Contract.
Makes effective use of available technology, including computers, e-mail, and voice mail in order to enhance customer service.
Maintains effective relationships with co-workers and customers based on courtesy, compassion, and respect.
Is responsible for other duties as assigned, consistent with established policy and procedures.
Required Knowledge Skills and Abilities:
Thorough knowledge of regulatory compliance requirements and quality assurance associated with public behavioral healthcare services and ability to design processes to monitor these requirements; knowledge and understanding of clinical services related to behavioral healthcare and associated payer sources; ability to engage in independent action and to take appropriate initiative based on agency policies, procedures and practices; excellent communication and interpersonal skills; ability to provide leadership in effective training, problem solving, and corrective actions to achieve compliance goals; ability to develop and maintain effective working relationships with a variety of professionals; ability to work as a part of a team; excellent attention to details and ability to meet necessary deadlines; project management skills and excellent computer skills.
Minimum Education and Experience: Minimum of a Bachelor’s degree in human services, public administration or related areas. Minimum of four years of experience that includes quality improvement, utilization review, OR any equivalent combination of education and experience which provides the required knowledge, skills, and abilities.
Equipment: Telephone, copy machine, computer hardware, designated software, adding machine.
Work Environment: General office environment with normal lighting levels, temperature, air quality, ventilation and noise levels.
Work Location: CSB offices located at North Main Street, Harrisonburg
Work Hazards: Minimal hazards associated with a human services environment.
Work Schedule: Regular office hours Monday through Friday; additional hours as needed to perform job requirements.