Clinical Review Specialist

Great benefits such as: Health, Dental, Vision, Life, & Disability Insurance Tuition Reimbursement Paid Personal Leave and Paid Holidays 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 providedare current, accurate, and meet all documentation/compliance requirementsin accordance with CARF, Medicaid, Department of Children & Families(DCF)/LSF, HIPAA, and SMA standards. Ensure that documentation in medical recordsadequately supports the service code that was billed. Complete audits as assigned each month. Identify and report trends and/or deficienciesto Clinical Compliance Manager. Writes legible, informative, and understandablenotices of non-compliance issues identified through reviews of clientrecords. Gather and prepare required documentation forexternal audits, including desk audits. Stay updated with CARF, HIPAA, Medicaid, Departmentof Children & Families/LSF, and SMA standards changes. Assist the Clinical Compliance Manager and performsrelated work as required or assigned. Performs miscellaneous job-related duties asassigned. Qualification Requirements To perform this jobsuccessfully, an individual must be able to perform each essential dutysatisfactorily. The requirements listed below are representative of theknowledge, skill, and/or ability required. Reasonable accommodations may be madeto enable individuals with disabilities to perform the essential functions. Minimum Education and/or Experience A minimum of a Bachelor's Degree, preferablywith a concentration in psychology, social work, mental health counseling, orhuman service-related field. Experienceworking in behavioral health preferred. Experience with Medicaid, DCF/LSF auditingand CARF accreditation is preferred. Knowledge/Skills/and Abilities Knowledge in behavioral health, knowledge of current practices anddocumentation requirements regarding the care and treatment of the populationserved. 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 andprocesses 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 standardspertaining to mental health service delivery. Ability to train, consult, and present improvement recommendationsto staff, committees, and others. Ability to evaluate and analyze systems problems and makerecommendations for corrective actions. Ability to complete work under strict timelines, while maintainingflexibility to assist with emergent issues/concerns; Ability to establish and maintain effective working relationshipswith co-workers, medical and clinical professionals, and the generalpublic. Necessary Special Requirements Possession of a valid Florida driver's license, acceptable drivingrecord, and proof of personal automobile insurance if required to drive an SMAvehicle and/or use a personal vehicle for SMA business. Complete State ofFlorida mandatory background screening prior to start of employment. Complete SMA required training during thefirst six (6) months of employment and updated if required. Physical Mobility and ability to bend andreach during an 8?12-hour day. Able to lift a minimum of 10 pounds. Visualand auditory acuity sufficient to evaluate, intervene, treat, and recordclient health care needs. Fine motor skills for legible and accuratecharting, daily correspondence, and presentation, either manually or orally. Routine8-hour shifts. Work endurance abilityto work 8?12-hour shifts with a meal break, as possible. Extra hours may berequired. Work assignment locations may vary. #J-18808-Ljbffr