- Dissects the current compliance performance of Medi-Cal charting and devises a plan that provides for statistically representative audit standard to ensure that audits are right-sized to compliance performance.
- Reviews current compliance program, mechanisms, and policies and recommends improvements if necessary.
- Supervises quality improvement team staff.
- Improves, meaningfully, the documentation quality throughout the agency.
- Ensures that Medi-Cal compliance programs for documentation has the following overarching goals: 1) supports excellent client care, and 2) removes as many burdens as possible from the staff doing the work.
- Schedules, coordinates, and conducts internal audits and clinical reviews/approvals of documentation as assigned and oversees direct service documentation to ensure compliance. Involves stakeholders appropriate to audit team.
- Onboards, trains, and evaluates BACS managers and staff against compliance regulations, program requirements, and data platforms.
- Develops, updates, and provides initial and ongoing training on documentation compliance to all levels of the agency according to a right-sized training schedule.
- Possesses a superior knowledge of BACS systems (Client Data System, Forms Manager, etc.) and county systems (CG, Sharecare, CHR, etc.), both the front end and back end, and is a 'super user' and trainer for all staff and leadership.
- Oversees chart review/utilization review processes, electronic medical records system, data collection/integrity for episodic data, and external chart audits/reviews. Acts as Chair of Internal Utilization Committee.
- Oversees, tracks and conducts Documentation Certification Processes and collaborates with the Program Manager on performance and corrective action plans. Delivers results to all stakeholders.
- Reviews and approves progress notes for all Medi-Cal programs as is appropriate. Provides feedback and trend analysis based on note writing standards.
- Billing Management. Oversees the billing function for Medi-Cal and other health insurance programs. Includes billing, recoupment, and liaison with the County and Billing outsource.
- Maintains knowledge of policies and procedures and regulations for standard work processes of those departments audited and regulatory and other program guidance.
- Supports with ensuring that all audits from regulatory agencies are conducted in an accurate, timely, and confidential manner, including: preparing audit materials, participating in the audit process, developing & leading completion of corrective action plans.
- Revise audit and compliance practices as needed to improve effectiveness in response to changing organization needs or new/revised regulations, policies and/or guidelines.
- Performs other duties as assigned.
- Influencing/negotiating skills and excellent oral and written communication. Political savvy.
- Partnering attitude; high integrity/honesty. Promotes accountability for self and others.
- Customer service and strength-based orientation. Embraces diversity in all aspects.
- Problem solving skills and conflict resolution skills.
- Resilience and demonstrated ability to embrace adversity. Ability and eagerness to promote continual learning.
- Demonstrate strong analytical and research skills. Maintain confidentiality of all audits, investigations, and findings at all times.
- Communicate effectively, orally and in writing, particularly in preparing reports.
- Meet deadlines in a timely manner. Work independently with minimal supervision.
- Professionalism, boundaries and confidentiality. Conducts all business professionally and represents the agency in the best light, while maintaining strict confidentiality.
- LCSW or MFT with current BBS registration strongly preferred.
- Five years of progressive experience managing Medi-Cal Specialty Mental Health charting plus a Bachelor degree may be substituted for licensure.
- Experience with HIPAA, Community Care Licensing (CCL), Medi-Cal, and medical billing.
- Experience in a leadership role providing direct staff supervision and department oversight.
- Demonstrated intermediate proficiency in Microsoft Office, Power Apps, ability to type 45WPM.
- Position requires a valid California driver's license, personal vehicle, and proof of personal vehicle insurance coverage and the ability to drive for work. DMV printout required.
- Highly competitive compensation, $85,000 unlicensed or $100,000 licensed, BBS registered.
- Fully paid medical, dental, vision, and life insurance coverage for employees and children.
- 33 days off (PTO/Holiday), increasing with tenure. PTO given on your birthday annually.
- 403b with BACS matching contribution
- After one year of service, $3000 per year for student loan debt, tuition, CEUs, etc. up to $15,000 over 5 years
- One month PAID sabbatical after 4 Years - not charging PTO
- Significant internal growth opportunities
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Medi-Cal Compliance Supervisor - Sacramento, United States - Bay Area Community Services
Description
Medi-Cal Compliance Supervisor
Do you have strong organizational skills, impeccably high standards, and a knack for quality assurance and compliance performance? The Medi-Cal Compliance Supevisor creates and implements a high functioning, efficient, effective Medi-Cal Specialty Mental Health charting and documentation program that adheres to all Medi-Cal regulations, laws, and other external requirements to assure that all clinical services are documented appropriately, within and exceed standards.
Hybrid 3/2 after succesfully completing BACS' 90 day introductory period with satisfactory performance and achievement of all job related goals and requirements.
DUTIES AND RESPONSIBILITIES
COMPETENCIES
QUALIFICATIONS
Bay Area Community Services is a CARF accredited non-profit, community-based agency celebrating 65 years of serving Alameda, Contra Costa, Monterey, Sacramento and Solano Counties by providing mental health and social services.
We are seeking individuals who want to transform clinical practice to be client-centered and effective in the field and who want to lead empowered teams to meet goals.
How to apply:
Submit a resume with a cover letter highlighting your relevant experience.
BAY AREA COMMUNITY SERVICES IS AN EQUAL OPPORTUNITY EMPLOYER
