Contract Compliance Assistant (50027)

WestCare Inc; Henderson (NV); On-site; USD 59,629,000 - 68,354,000; Full time

Job summary

WestCare Inc in Henderson, NV seeks a Quality Assurance/Documentation Specialist to ensure Medicaid, Medicare and related funding documentation meets chapter and contract guidelines. The role focuses on clinical records review, interdepartmental communication, and maintaining compliance across programs.

You will develop monitoring tools, conduct site reviews, and manage the agency’s electronic health record system.

Qualifications

• Bachelor’s degree from an accredited institution.
• Previous QA experience in behavioral health preferred.
• Knowledge of Medicaid/Medicare documentation guidelines.

Responsibilities

• Perform clinical records review to ensure compliance with Medicaid/Medicare and funding guidelines.
• Develop and/or utilize monitoring tools and processes for compliance across programs.
• Conduct quality assurance site-based reviews of client files.
• Maintain and utilize the agency’s electronic health record system.
• Prepare concise reports and distribute to management on a defined basis.

Skills

HIPAA regulations

Quality assurance (QA)

Records review

Microsoft Office

EHR system

Education

Bachelor's degree

Tools

Electronic health records (EHR)

Job description

Job Details

Location: Henderson - 1711 Whitney Mesa - Henderson, NV 89014. Position Type: Full Time. Education Level: 4 Year Degree. Salary Range: $20.81 - $20.81 Hourly. Job Shift: Any.

Position Summary

Person in this position will be responsible for assisting the agency in ensuring that documentation requirements for Medicaid, Medicare and other funding sources per chapter and contract guidelines are adhered to. Responsibilities include but are not limited to: clinical records review, medical records, and interdepartmental communication.

Essential Job Functions

• Possess and/or develop expertise in the areas of quality documentation and records review in relation to Medicaid/Medicare regulations and all other federal, state and local rules and regulations that apply to WestCare Nevada’s specific programs.
• Develop and/or utilize existing monitoring tools, forms, processes and implement systems for compliance in all programs which will ensure that the programs and individuals meet documentation requirements and clinical records through monitoring.
• Conduct quality assurance site-based reviews of client files.
• Possess and/or develop expert proficiency in WestCare Nevada’s electronic health record; in the client file, service manager, and reporting features.
• Attend staff meetings, training and in-service as assigned by supervisor and/or as required by the agency.
• Develop concise and timely reports, including reports by program regarding client file reviews, as necessary and distribute reports to the management team on a defined basis.
• Handle CARF Service Claims Audit reports quarterly including facility reports to Billing Supervisor.
• Conduct supportive administrative assistant-type duties as needed.
• Embrace and embody the mission, vision, guiding principles, clinical vision and goals of WestCare Foundation.
• Perform all other duties as assigned.

Qualifications

Certifications / Licenses

• Ability to pass first level and NABS background clearance.

Education

Bachelor’s degree from accredited institution with previous demonstrated QA experience in behavioral health field preferred.

Experience and Competencies

• Experience working with a substance abuse population is preferred.
• Excellent language and interpersonal skills.
• Knowledge of HIPAA regulations and guidelines.
• Superior organizational skills and attention to detail.
• Strong computer skills, to encompass all Microsoft Office Platform Applications.
• Knowledge of electronic record keeping systems.

Working Conditions

Work is performed primarily in a professional, office setting, with some travel between specified facilities/locations required. A minimum of 40 hours per week are expected but additional hours may be required from time to time. Regular attendance is required.

Essential Physical and Mental Demands of the Job

Physical Demands

• Requires mobility and physical activity: adequate range of body motion and mobility to work in an office, residential, or outdoor environment including standing and walking (even and uneven surfaces), sitting for extended periods of time, bending, twisting, reaching, balancing, occasional lifting and carrying of up to 30 pounds.
• Use of computer and telephone systems is required which includes coordination of eye and hand, and fine manipulation by the hands (typing, writing, and working with files).
• Requires the ability to defend oneself and clients in physically abusive situations through the use of approved physical de-escalation techniques.
• Requires talking: Expressing or exchanging ideas by means of the spoken word. Talking is required to impart oral information to employees, clients, patients, and the public, and in those activities in which the employee is required to convey detailed or important spoken instructions to others accurately, loudly, or quickly.
• Requires hearing: Hearing is required to receive and communicate detailed information through oral communication.
• Requires seeing: Clarity of vision at 20 inches or less and at distance. This factor is required to complete paperwork for many of the employee’s essential job functions and to observe client behavior and activities in and out of the facility.

Mental Demands

• Requires the ability to collect and analyze complex numerical and written data and verbal information to reach logical conclusions.
• Requires the ability to work and cooperate with clients, co-workers, managers, the public and employees at all levels in order to exchange ideas, information, instructions and opinions.
• Requires the ability to work under stress and in emotionally charged settings.
• Requires the ability to be self-directed and performance/outcome driven; with limited supervisory or managerial oversight.
• Requires the ability to defend oneself and clients in mentally/verbally abusive situations through the use of approved mental/verbal de-escalation techniques.

The normal work routine involves no exposure to human blood, body fluids or tissues. However, exposure or potential exposure may be required as a condition of employment. Appropriate personal protective equipment will be readily available to every employee.