Quality Compliance Specialist

Quality Assurance & Compliance Specialist The Quality Assurance & Compliance Specialist supports the organization's Quality Assurance, Performance Improvement, and Compliance Program by conducting clinical documentation reviews, monitoring regulatory compliance, analyzing quality data, and assisting with continuous quality improvement initiatives across MCMH's Certified Community Behavioral Health Clinic (CCBHC) . The Quality Assurance & Compliance Specialist assists in ensuring that clinical and operational services comply with all applicable federal, state, and local regulations, including the New York State (NYS) CCBHC Part 600.1 Regulations, applicable regulations of the NYS Office of Mental Health (OMH), applicable regulations of the Office of Addiction Services and Supports (OASAS), and Medicaid Part 521 Regulations, as well as organizational policies and protocols. The Specialist collaborates closely with clinical, administrative, and leadership staff to promote documentation excellence, regulatory compliance, patient safety, and continuous quality improvement. The ideal candidate possesses a strong knowledge of behavioral health clinical documentation, regulatory compliance, and quality improvement principles. Experience evaluating clinical documentation, medical necessity, treatment planning, and compliance with CCBHC, OMH, OASAS, and Medicaid requirements is highly desirable. Master's degree in Social Work, Psychology, Public Health, Healthcare Administration, Counseling, Nursing, or a related field preferred. Minimum of two (2) years of experience in quality assurance, quality improvement, compliance, utilization review, clinical documentation review, or medical records within a behavioral health setting. Working knowledge of New York State behavioral health regulations, including OMH, OASAS, Medicaid, HIPAA, and CCBHC Certification Criteria. Strong knowledge of behavioral health clinical documentation, person-centered treatment planning, medical necessity, documentation standards, and quality assurance principles. Working knowledge of behavioral health risk management principles, incident reporting, patient safety practices, and corrective action processes. Experience conducting clinical chart reviews, documentation audits, and quality monitoring activities. Proficiency in behavioral health Electronic Health Record (EHR) systems and Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint). Strong analytical, organizational, critical thinking, problem-solving, written, verbal, and interpersonal communication skills. Ability to work independently while collaborating effectively with interdisciplinary teams. Preferred Qualifications Current New York State Licensed Clinical Social Worker (LCSW) or Licensed Psychologist is strongly preferred. Experience working within a Certified Community Behavioral Health Clinic (CCBHC). Experience interpreting and applying OMH, OASAS, Medicaid, and CCBHC documentation and regulatory requirements. Experience providing clinician education, documentation coaching, or quality improvement feedback. Experience with quality dashboards, performance measurement, data analysis, and quality reporting. Experience participating in regulatory surveys, compliance audits, performance improvement initiatives, and corrective action activities. Experience working with individuals from a broad range of backgrounds and communities. Responsibilities Clinical Documentation Review & Quality Assurance Conduct routine and targeted clinical chart reviews to evaluate compliance with organizational policies, CCBHC, OMH, OASAS, Medicaid, HIPAA, and other applicable regulatory requirements. Review clinical documentation for completeness, accuracy, timeliness, medical necessity, person-centered care, treatment planning, progress notes, risk assessments, informed consent, and other required documentation. Identify documentation deficiencies, compliance risks, quality trends, and opportunities for quality improvement, and prepare audit findings and recommendations for the QA Coordinator and Quality Department leadership. Collect, validate, analyze, and maintain audit data, quality metrics, CCBHC quality measures, organizational performance indicators, audit records, compliance tracking tools, and other databases. Participate in internal audits, focused reviews, corrective action activities, and initiatives to improve documentation timeliness and reduce outstanding clinical documentation. Regulatory Compliance Assist in monitoring compliance with applicable federal, state, and local behavioral health regulations, CCBHC Certification Criteria, and organizational policies. Support organizational readiness for CCBHC certification, regulatory reviews, OMH and OASAS audits, Medicaid reviews, accreditation surveys, and related reporting requirements. Monitor care coordination, access to care, person-centered treatment planning, quality and outcome measures, and the implementation of corrective action plans to support ongoing regulatory compliance. Promptly report identified compliance concerns to the QA Coordinator. Performance Improvement Assist in implementing Quality Assurance and Performance Improvement (QAPI) initiatives using established quality improvement methodologies. Participate in quality improvement initiatives that enhance documentation quality, clinical practice, regulatory compliance, patient safety, access to care, integrated behavioral healthcare, population health, trauma-informed and recovery-oriented services, and patient outcomes. Monitor quality indicators, clinical outcomes, operational performance measures, and performance trends; contribute recommendations and improvement activities based on audit findings, performance data, and identified barriers to care. Education & Staff Support Provide feedback to clinicians regarding documentation quality and regulatory requirements. Assist with clinician education related to documentation standards and quality improvement initiatives. Support the development of educational materials, tip sheets, and quality resources. Reinforce organizational documentation standards and best practices. Work collaboratively with the Quality Assurance Coordinator, Director of Quality & Compliance, program directors, clinical leadership, clinicians, administrative staff, and interdisciplinary teams to support departmental goals and quality improvement initiatives. Participate in Quality Assurance, Performance Improvement, Compliance, Risk Management, CCBHC, and other organizational committees as assigned. #J-18808-Ljbffr