Quality & Compliance Specialist

Job purpose
The general purpose of your job is to keep children who are clients of HOTI safe at all times and to be respectful of the children and their families as valued customers.

The primary purpose of the Quality & Compliance Specialist position is to support the facilitation of quality management and performance improvement processes by serving as a data analysis, billing auditor, denial management, accounts receivable subject matter expert (SME) for all Behavioral Health Services and Long Term care Kosair for Kids Complex Care Center (KCC), in order to ensure the highest quality of care for residents, clients, service recipients, patients, and organizational adherence to best practices and regulatory requirements.

Duties & Responsibilities
• Models the organization’s core values of compassion, wellness, excellence, and empowerment to all internal and external contacts. (Daily/Ongoing)
• Models Sanctuary commitments of nonviolence, emotional intelligence, social learning, democracy, open communication, social responsibility, and growth and change. (Daily/Ongoing)
• Responsible to monitor through evaluating the quality, necessity, and effectiveness of services provided, and ensure compliance with regulatory, billing, and/or contractual documentation requirements. (Monthly)
• Responsible for data collection and analysis related to quality monitoring activities, preparation of summary reports, and presentation of findings to applicable committees (i.e., Quality Improvement Committee, Corporate Compliance Committee, Service Recipient Quality Advisory Council, Risk Management Committee, etc.). (Quarterly)
• Provides Ethical Boundaries training. QI/CC training, and Compliance training.
• Provides assistance with quality-of-care reviews/investigations, including preparation of investigative summaries to be reported to the Corporate Compliance Committee. (As Needed)
• Participates in activities to support accreditation readiness, assists with compilation of required evidence, and participates in the site survey process. (As Needed)
• Participates as a member on the Sanctuary Core Team, assisting with training, psychoeducation, re-certification preparation, mock site survey process, and evidence collection. (As Needed)
• Participates in activities/projects related to data collection for the organization, data analysis, identification of opportunities for improvement, preparation of reports and summaries, and presentation of related findings as needed.
• Assists with the development, revision, and implementation of written policies and procedures necessary for successful implementation of the QI/CC Department. (As Needed).
• Participates in activities, as assigned, to ensure compliance with organizational policy, procedures, regulations, and best practices, including (but not limited to) periodic review of program and/or client records and assistance with evaluation, tracking, or investigation related to Quality of Care (QOC) concerns and/or corporate compliance complaints/issues.
• Responsible for activities related to the development, coordination, facilitation, and tracking of training related to QI, Compliance, and Accreditation for the organization, as assigned by the CQCO.
• Performs other duties as assigned by the Chief Quality & Compliance Officer (CQCO). (As Needed)

Qualifications
• Bachelor’s degree required; preferred in human services or healthcare-related field. (Experience may substitute for field of study, but not for the minimum degree requirement.)
• A minimum of two years of experience performing duties related to quality improvement, patient safety/risk management, compliance, or accreditation is required.
• Ability to maintain objectivity in decision making, maintain strict confidentiality related to client/patient care and/or other sensitive matters, and work independently in a leadership capacity is required.
• Intermediate experience with technical programs, including Microsoft Excel, Word, PowerPoint, and Outlook is required.
• Experience working directly with children and/or families in a behavioral health, mental health, other healthcare delivery, or educational setting is strongly preferred.
• Demonstrated organization, facilitation, written and oral communication, and presentation skills.
• Knowledge and experience in state and federal information privacy laws, including but not limited to HIPAA.
• Professional certification as a Certified Professional in Healthcare Quality (CPHQ) is preferred.
• Professional certification as a Certified in Healthcare Compliance (CHC) is preferred.

Working conditions
• Works in office areas, moves intermittently throughout the facility, and is subject to frequent interruptions.
• Work hours are flexible and may extend into evenings and weekends if necessary.
• Occasional travel may be required for training, conferences, or other professional development opportunities.

Physical requirements

• Must be able to move intermittently throughout the workday.
• May be necessary to assist in the evacuation of residents during emergency situations.
• May be required to sit or stand for extended periods of time.

Direct reports

N/A