CLINICAL AUDIT SPECIALIST

Job Description

Job Description

Description:

We are Hiring!

Job Posting: Clinical Audit Specialist

Location: Rochester, NY

Department: Quality & Compliance

Employment Type: Full-Time

Schedule: M-F, 8:30am-4:30pm

Salary: Exempt, $62,353- 65,000 DOE

As a regional agency of Catholic Charities of the Diocese of Rochester, Catholic Charities Family and Community Services (CCFCS) has been serving our community for over 100 years. We walk with people when they are at their most vulnerable as they journey toward independence to reach their full human potential, advocate for those in need throughout all stages of life; and work in partnership with faith communities of all denominations and those who are committed to addressing local needs.

If you’re looking for an opportunity to express and explore your passion for helping others, then join a team that truly makes a difference DAILY, in people's lives. Don't miss out on being a part of something special!

General Description

The Clinical Audit Specialist conducts objective, clinically rigorous chart reviews using the organization’s OMH and OASAS aligned Clinical Review Tools to ensure compliance with OMH and OASAS regulatory standards, accuracy of clinical information, and adherence to organizational policies. This role supports quality improvement initiatives and helps maintain high standards of an individual’s care. This role functions as an independent clinical quality assurance resource, ensuring documentation accurately reflects clinical work provided, supports medical necessity, and meets regulatory and payer requirements.

The position operates within a continuous quality improvement (CQI) framework, emphasizing strengths-based feedback, targeted coaching, and linkage to training rather than disciplinary action.

Essential Duties and Responsibilities

• Coordinates with Director of Quality Assurance and Compliance annual schedule of clinical audits.
• Conduct routine, focused and follow up clinical chart audits using standardized tools to ensure completeness, accuracy, and compliance with state, federal and organizational guidelines.
• Identify documentation gaps, inconsistencies, or errors and communicates findings to clinical staff for correction.
• Reviews documentation across assessment, treatment planning, progress notes, group documentation and discharge planning
• Apply consistent scoring aligned with established standards and interpretation guides
• Ensures charts meet requirements of HIPAA, Joint Commission and other applicable regulations.
• Identifies documentation strengths and improvement opportunities and collaborates with supervisors and clinicians to support remediation.
• Develops and supports strength based Corrective Action Plans when indicated.
• Supports peer reviewers and supervisors in understanding audit standards
• Prepares summaries and reports of audit findings for management and quality improvement committees.
• Link audit findings to appropriate training and Continual Quality Improvement initiatives
• Contributes to identification of system-level trends and documentation gaps
• Assists in developing educational material related to documentation, compliance or procedures
• Investigates and monitors issues of non-compliance and coordinates with the program to implement appropriate internal controls
• Recommends future course of action based on audits and data analysis
• Conducts training and provides updates regarding internal controls and regulatory compliance
• Adheres to all applicable federal and state laws, as well as CCFCS internal policies, including but not limited to those governing client confidentiality, privacy, program standards and billing and documentation standards
• Maintains high level of expertise in specialized areas through continuing education, individual contacts, and attendance at appropriate meetings
• Attend mandatory training.
• Actively pursues development of professional competencies related to job performance through reading, supervision, in-service training and attendance at conferences and workshops.
• Attend staff meetings and other agency committee meetings as appropriate to duties and responsibilities and communicate information directly to appropriate staff.
• Represent Catholic Charities Family and Community Services on appropriate committees.
• Awareness and active support of the Agency's Mission, Vision, Values and Strategic Plan. Including, but not limited to, supporting the Agency's Core Competency initiatives of being Collaborative and Community Focused, Innovative and Entrepreneurial, and Culturally Competent and Diverse.
• Other duties as assigned

Note: The above description is illustrative of tasks and responsibilities. It is not meant to be all inclusive. Employees are required to follow appropriate supervisory direction and perform other related duties as required.

Qualifications

Education: Master’s Degree in Social Work, Mental Health Counseling, Psychology, Nursing or related field.

Equivalent combination of education and experience will be considered.

Credentials: Licensed Master Social Worker (LMSW) preferred.

Experience: 2+ years of behavioral health clinical experience, familiarity with electronic health record (EHR) systems.

Preferred experience in quality assurance, utilization review or clinical auditing.

Experience with Trauma-Informed care and integrated behavioral health models.

Familiarity with NYS OMH including HCBS and OASAS regulations and Medicaid Managed Care requirements.

Familiarity with OMIG audit processes and Medicaid documentation.

Physical Demands/Work Environment: The physical demands/work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to sit, talk, hear, stand, walk, use hands to type and/or perform light lifting. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus. The noise level in the work environment is usually quiet.

Compliance: Adheres to all applicable federal and state laws and regulations including, but not limited to, those governing confidentiality, privacy, program, billing and documentation standards. All duties must be performed in accordance with CCFCS’s corporate compliance & ethics program. Any offer of employment will be contingent upon successful completion of a background check. CCDOR considers all background check information in accordance with applicable law.

Top Benefits and Perks:

• Competitive salary and 403b retirement plan
• Generous time off package and work-life balance
• Comprehensive benefits package
• Supportive and collaborative environment
• Opportunities for growth and development
• Intrinsic reward of truly making a difference in people's lives

Join us and help make a positive impact on our community!

***Catholic Charities is committed to leveraging the talent of a diverse workforce to create great opportunities for our agency and our people. EOE/AA Disability/Vet