Quality Assurance Specialist

Referrals Specialist

Counseling 4 Kids is a resilient community mental health agency driven by our steadfast commitment to quality care and unparalleled dedication to client engagement. At the core of our mission is a profound belief that every child deserves compassionate support and effective treatment. We prioritize our clients above all else, ensuring their needs are met with empathy and expertise.

Our agency is not just a place of work; it's a dynamic environment where innovation, teamwork, and resilience flourish and where resilience is valued. We embrace creativity and collaboration, fostering a culture of welcoming and nurturing new ideas. Our commitment to staff well-being is paramount, providing a supportive and inclusive atmosphere where every team member can thrive and grow professionally.

As we continue to evolve and expand our services, we invite visionary leaders in mental health to apply for our Referrals Specialist position. This pivotal role offers the chance to shape our agency's future, lead a dedicated team of professionals, and profoundly impact the lives of children and families in our community. If you are passionate about transforming lives, driving innovation, and upholding the highest standards of care, Counseling4Kids is the place for you.

This is for a contracted employee role, with an expected duration of six (months). At the end of the contracted period of employment, job performance, attendance, attitude and overall interest in the job will be assessed in a performance evaluation to determine if an offer of full-time at will employment will be made, if the contract period will be extended, or if the contract will be ended without further offer of employment.

Job Summary: The Quality Assurance Specialist I (QAS) assists Counseling4Kids (C4K) in maintaining compliance with agency, Los Angeles County Department of Mental Health's (DMH), and state requirements (DHCS and Medi-Cal) for Mental Health Treatment. Under the guidance/direction of the Quality Assurance and Improvement Director (QAID), QAS participates in Quality Assurance (QA) and Quality Improvement (QI) activities including chart reviews, data entry, documentation tracking, monitoring of contract performance, and assisting with training staff. The QAS is tech savvy, detail oriented, able to work independently, collaborative with multiple levels of professionals, demonstrates initiative and curiosity, and has a willingness to support colleagues and client services at C4K.

Essential Functions:

• Upholds compliance with HIPAA, mandated reporting, and other healthcare laws and agency policy
• Processes record requests, distribution of information, and/or communication within laws & regulations
• Implements timely data collection, entry, and reporting within agency standards and to meet contract requirements
• Completes administrative reviews of clinical records, updates reporting on client admission, engagement, and discharge dates, and assists with evidence-based practices (EBPs) compliance.
• Tracks outstanding compliance issues to ensure resolution in a timely manner
• Participates in agency goal of 5% utilization reviews of active clients on a quarterly basis and updates tracking
• Tracks corrections and completion of compliance forms, completes regular data entry within DMH systems for staffing and program tracking
• Processes requests for Client Information and Disclosures as directed
• Performs quality survey calls with community-based clients, as directed by QAID
• Attends internal departmental, agency-wide, and county-wide meetings, as directed by QAID
• Seeks technical support both internally and externally to resolve issues related to quality and compliance
• Assists with committee events and transportation of necessary items, as requested
• Completes staff enrollment and disenrollment within internal and external systems (i.e. Exym and NAPPA)
• Supports billing processing and resolving outstanding claim issues, by problem solving errors and issues related to staff profiles, billing code usage, and/or cross-system communications (i.e. Exym, NAPPA, IBHIS)
• Manages staff certification tracker and collaborates across departments for certificate renewal, as needed
• Completes client program changes in EXYM (i.e. changing funding source, program type, EBP, etc.)
• Collaborates with QA/QI team to resolve discrepancies within, but not limited to: Diagnosis (EXYM/IBHIS) reports; problem list/SNOMED-CT updates; client profiles in IBHIS, EXYM and Medi-Cal systems; Psychiatric consents
• Reviews, tracks and files of consumer perception surveys (CPS) to ensure that departmental completion rate goals are achieved
• Serves as a support role for quality assurance training during onboarding of new staff
• Participates in agency training to maintain current knowledge of quality assurance policies and procedures. Assists with the development of training materials for assigned projects

Minimum Qualifications:

Education:

• BA in healthcare administration, psychology, social work, public health, or related field -OR-
• AA degree in related field and minimum of 2 years relevant work experience

Work Experience & Skills:

• Two (2) or more years' work experience within a healthcare setting
• Experience with DMH policies, procedures, tracking/reporting systems preferred
• Knowledge of billing codes and/or processing claims preferred
• Knowledge of HIPAA and client privacy standards
• Experience with Electronic Health Records, preferably Exym
• Skilled use of Microsoft Suite (i.e. Outlook, Word, and Excel)
• Clear written and verbal communication skills with the ability to be resourceful and proactive when issues arise.
• Bilingual English/Spanish preferred

EEO Statement:

Counseling4Kids provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Counseling4Kids complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.