Senior Quality, Billing & Reporting Specialist

Job Description

Job Description

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The Senior Quality, Billing and Reporting Specialist is responsible for improving agency performance and service delivery through data-driven analysis, continuous quality improvement (CQI), and regulatory compliance. This position ensures accuracy and integrity of clinical and administrative data, supports efficient workflows, monitors documentation quality, and assists in meeting all federal, state, and contractual requirements. Working collaboratively with direct service programs, administrative departments, and leadership, The Senior Quality, Billing and Reporting Specialist enhances operational efficiency, promotes a culture of quality and safety, and helps ensure the agency’s adherence to behavioral health best practices.

Qualifications:

1. Highschool diploma or GED required.
2. Bachelor’s degree in Behavioral Health, Data Analytics, Public Health, Health Administration, or related field preferred.
3. Minimum of three (3) years of experience in quality assurance, or compliance within a behavioral health or healthcare setting.
4. Working knowledge of statistical analysis, data interpretation, and report generation preferred.
5. Strong written and verbal communication skills, with the ability to provide clear feedback and training.
6. Experience using and managing Electronic Health Record (EHR) systems preferred.
7. Advanced proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, and Outlook), including the ability to create complex spreadsheets, develop professional presentations, and manage data using formulas, charts, and pivot tables.
8. A valid California driver’s license is required for staff who have regular driving duties, and the driving record must meet the requirements of their position and be approved by the agency’s insurance company.

Essential Job Functions:

1. Strong computer skills and working knowledge of database systems.
2. Foster a culture of continuous improvement, ability to identify inefficiencies and suggest enhancements to products and processes.
3. Ability to collaborate effectively across departments while managing multiple priorities.
4. Ability to communicate ideas in oral and written form.
5. Protect and honor individual integrity through confidentiality.
6. Ability to work effectively with cultural/ethnic diversity.
7. Ability to work in a harmonious manner with subordinates, supervisors, and across departments.
8. Adequate physical, mental, and emotional health to perform duties.

Responsibilities:

1. Conduct routine audits of clinical and administrative documentation within the EHR to ensure accuracy, completeness, and compliance with agency policy, payer requirements, and regulatory standards Health Insurance Portability and Accountability Act (HIPAA), Department of Health Care Services (DHCS), Joint Commission, Centers for Medicare & Medicaid Services (CMS), etc.
2. Identify deficiencies and trends in documentation or processes; collaborate with staff and supervisors to develop and monitor corrective action plans.
3. Assist with preparation for external audits, accreditation reviews, and licensing inspections.
4. Participate in risk management activities, including incident tracking, root cause analysis, and implementation of performance improvement plans (PIPs).
5. Support the development, review, and updating of agency policies and procedures to align with current regulations and best practices.
6. Facilitate communication across departments to ensure data-informed decisions and alignment with agency goals.
7. Provide education and feedback to staff regarding documentation standards, data accuracy, and quality expectations.
8. Assist leadership in developing and evaluating performance metrics and outcome measures.
9. Work closely with other departments and the Finance Team to analyze information, resolve billing issues, and ensure accurate financial reporting.
10. Demonstrate knowledge of proper coding and processing of incoming Explanation of Benefits and Remittance Advice from payers.
11. Manage all stages of the revenue cycle, including claim creation, denial management, and payment position, to ensure maximum reimbursement.
12. Monitor claim progression daily, manage reports, and submit monthly updates and supporting documentations on billing activities to the Director.
13. Responsible for preventing and controlling infection.
14. Responsible for maintaining a culture of quality and safety.

Other:

1. Attend all required meetings and trainings.
2. Report any suspected child or dependent adult/elder abuse or neglect immediately to direct supervisor or utilize the chain of command if supervisor is unavailable.
3. Report any client imminent danger to self or to others or gravely disabled immediately to direct supervisor or utilize the chain of command if supervisor is unavailable.
4. Other duties as assigned.