[Hiring] Quality Documentation and Support Specialist @Sunshine Behavioral Health

Title:

Revenue Cycle Quality Documentation and Support Specialist

Location:

Home Office - Remote

Schedule:

Typical Office Hours

Salary:

$65,000 - $70,000 per year

About us:

Do you want to help save lives? Do you want to help people change their lives for the better?

At Sunshine Behavioral Health, that’s what we do! We are a leader in recovery and mental health services. Our mission is to provide the highest quality substance abuse treatment services and deliver them with passion, integrity, and company spirit. Through our programs, individuals receive the tools to overcome their alcohol/drug dependencies and learn to manage co-occurring disorders. For more information about Sunshine Behavioral Health, visit us at www.sunshinebehavioralhealth.com

Role Summary:

The Revenue Cycle Quality Documentation and Support Specialist is responsible for ensuring the accuracy, consistency, and quality of medical documentation across all facilities within Sunshine Behavioral Health. This role includes conducting comprehensive chart audits, developing training materials, enhancing compliance processes, and collaborating with various departments to meet regulatory guidelines and improve the overall quality of medical and clinical documentation. The position requires strong knowledge of LOCUS and ASAM criteria, as well as experience with utilization review and revenue cycle management.

Responsibilities:

1. Chart Auditing and Documentation Quality Control:

• Conduct daily medical completion audits across all facilities to ensure documentation accuracy and compliance.
• Review charts for Medical, Completion, and Quality to maintain high best practice guidelines and standards of documentation.
• Provide feedback and recommendations for improvement to departments based on audit findings.
• Consistently update and enhance completion and quality matrices to align with payor guidelines.
• Creating the proactive ability to adapt to upcoming changes within payor structures and guidelines with ASAM, LOCUS, InterQual, ABA, MCG, TAC guidelines and more.

2. Issue Tracking and Resolution:

• Monitor and track issues identified during audits and collaborate with relevant departments to address them.
• Support departments with outstanding audit feedback and communication to improve compliance and quality.
• Evaluate RCM supervisors internal reporting performance opportunities, issues, and educational needs to improve (Benefits, Authorizations, claim submission, Claim follow up, and Payment posting) to help assist and hold stakeholder accountable in integrity improvements with our payors.

3. Reporting and Documentation:

• Assist and Generate Billing on Hold - Pending Authorization and UR Audit Monthly Reports and feedback to enhance education improvements in the UR department and enhancement in medical record and external audits.
• Assist and prepare biweekly completion and quality reports for each facility and deliver findings to relevant stakeholders.
• Holding Provider Vendor and Facilities accountable for weekly provider follow-up session within Residential and PHP treatments to shield company from external performance audits, credentialing, and contracting obligations to void claw backs and other identified risks.

4. Training and Education:

• Assist, develop, update, and revise Standard Operating Procedures (SOPs) and training materials for medical records enhancement (across facility departments: compliance, medical, nursing, operations, clinical, and within standard Quality Audit Dept)
• Assist in development and creating improvement-focused educational documentation platforms to support department training.
• Assist and conduct training sessions virtually or on-site (boots on the ground) to ensure staff comprehension and adherence to protocols.

5. Collaboration and Communication:

• Coordinate with Medical Records, Utilization Review (UR), and Facility departments to address documentation needs.
• Serve as an advocacy and support to the liaison between departments to ensure seamless communication and feedback.

6. Quality and Compliance Initiatives:

• Participate in the Documentation Quality Enhancement Project aimed at improving medical record accuracy and consistency.
• Work with departments to develop processes that align with regulatory requirements and enhance compliance.
• Assist in performing monthly write-offs (W/O) auditing and reporting to RCM leadership to assist with billing opportunities, issues, and both internal and external audits of revenue losses.

Additional Functions

• Completes other duties assigned by VP Revenue and Data Strategy and RCM Quality Documentation Liaison.
• Provides input to department training and level up policies and procedures.
• Assesses and communicates staff development needs to the RCM department managers and Director
• On occasion may assist with the training of staff based on trends identified.
• Retraining and assisting in Utilization review management (SUD/MH)
• Retraining to be up to date with UR changes and experiences with Auditing the UR team
• Assisting with support and training new UR members and enhance their growth and improvement in written and verbal platforms to help with client advocacy and medical records support for continued care within treatment.
• Assist and support with UR team if needed due to staffing and high census

Qualifications:

• Bachelor’s Degree or Higher Preferred, Associate’s required.
• Additional relevant education around billing
• Minimum five (5) years' experience within Behavioral Health Services: (Substance and Mental Health treatment facilities).
• Familiarity with payor guidelines and revenue cycle management metrics.
• Familiarity with Utilization Management and front-line support management (Clinical, Nursing, and/or Medical)
• Strong understanding of LOCUS, ASAM, InterQual, ABA, MCG, TAC criteria and guidelines.
• Proven experience with utilization review, revenue cycle management, and chart auditing.
• Excellent communication, training, and organizational skills.
• Ability to create and enhance training materials and SOPs.
• Strong analytical and problem-solving skills.
• Proficiency in working with medical record systems and documentation platforms.
• Detail-oriented with a commitment to maintaining high standards of accuracy and compliance.
• Understands A/R management concepts for behavioral health billing office operations
• Experience understanding billing and/or collections with commercial insurance plans and/or self-pay
• Medical billing software expertise in (but not limited to): Salesforce, Tableau, CDM, and KIPU
• Excellent written and verbal skills and demonstrates the ability to manage workload be self-efficient and prioritize while multi-tasking in a fast-paced environment
• Insight into AI development
• Critical thinking skills
• Strong computer skills (Word, Excel, PowerPoint)
• Strong ability to grasp new concepts and apply them.
• Strong ability to understand complex workflows and follow procedures

Minimum Requirements:

• Associate’s Degree

Physical Requirements:

• Role is generally performed at a desk.
• During remote work, employee is responsible for ergonomic requirements and a work area free from distractions.
• Role is performed using computer (including screen, keyboard, mouse, etc), phone, and other typical office equipment.
• Significant phone work including talking and listening.
• Ability to interact in Microsoft teams platform.
• Ability to travel up to 10% for training at new locations.
• Regular, predictable attendance.
• Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Benefits:

• A comprehensive benefits package, including medical, dental, and vision coverage.
• Paid time off, paid holidays, sick time, and 401K with company matching.
• The opportunity to be part of a mission-driven organization where you’ll feel connected to the work you do, knowing that you’re directly helping individuals on their path to recovery.

Sunshine Behavioral Health is an equal opportunity employer and prohibits discrimination and harassment of any kind.