Quality Assurance Compliance Specialist - PSS

This is an internal job posting. Only former Multnomah County employees on an active recall list may apply for this opportunity through this site.

Current employees: Please apply through the employee portal to be considered for this opportunity.

Pay Range:

$42.71 - $52.58 Hourly

Department:

Health Department

Job Type:

Regular Represented

Exemption Status:

United States of America (Non-Exempt)

Closing Date (Open Until Filled if No Date Specified):

The Opportunity:

THIS WORK MATTERS!

This position is in the Quality Management (QM) and Compliance Program of the Behavioral Health Division (BHD). The QM/Compliance Program focuses on quality assurance and quality improvement processes, measurement of performance and quality indicators, and monitoring of compliance standards for contracted providers and county behavioral health (BH) services. This position works closely with programs in BHD that provide billable clinical services. This includes programs under the OAR 309-019 rule set.

Knowledge, Skills and Abilities (KSA): 

• Any working knowledge of contract compliance criteria and quality indicators. 

• Any experience in conducting audits or investigations, including data collection, analysis, recommendations for corrective action and compliance monitoring. 

• Experience with Medicaid billing, managed care systems, and/or health plans.

As the Quality Assurance Compliance Specialist - Program Specialist Senior (PSS) other duties will include:

Compliance Oversight and Clinical Standards Review

• Provide subject matter expertise on compliance and regulatory requirements for BHD programs that provide clinical outpatient mental health and addiction services. 

• Be the clinical consultant for the Quality Management Compliance team on any matter that requires a QMHP or licenses staff lens, including, but not limited to critical incident, grievances, OAR interpretation and policy and procedures. 

• Provide expertise and technical assistance to drive initiatives, support programs in improving outcomes or services, and implement requirements. 

• Conduct work flow analysis to identify areas for improvement, simplify redundant processes, and address quality assurance/compliance requirements. 

• Identify problems and formulate solutions independently or through consensus with community providers, Oregon Health Authority (OHA) and the teams. 

• Collect and analyze information regarding the implementation of policy decisions, and analyze the effect of policy decisions upon service delivery and operations. 

• Monitor program compliance with OARs regarding provision of services, standards of care, and client health and safety.  

• Provide technical assistance when needed/requested by any of the teams. Assist Quality Management and leadership teams with tracking Rule Advisory Committee meetings and provide engagement with rule changes, including in-person meetings, written feedback and comments and communication back to the team about how rule changes may impact work/workload as needed. 

• Independently conduct research around rules, regulations, requirements, best practices and evidence based practices. 

• Work closely with the BHD Billing team to review and resolve potential claims issues that could be related to fraud, waste and abuse.

• A general understanding of billing and claims rules are required for this position.

Complaints, Grievances and Incident Reviews

• Apply quality assurance and quality improvement concepts and principles when evaluating incidents and grievances in BHD service programs and consult on incidents within BHD. 

• Analyze data for opportunities for improvement. 

• Conduct Peer Reviews and Root Cause Analysis (RCA) and formulate a critical Incident Review Report and other investigative reports, as needed. 

• Evaluate incidents to be sent through established Peer Review Processes and conduct Root Cause Analysis/Critical Incident Reviews. 

• Write Critical Incident Summaries and Investigative reports. Monitor and report program violations. 

• Track corrective action plans and recommended action compliance based on RCA’s with BHD programs. 

• Maintain incident report and grievance folders and databases. 

• Provide Leadership Team incident report information for BHD reviews and trend analysis, quarterly. 

• Provide Director’s Office leadership regular reports on trends and systems issues from data collected through BHD incident reports and/or Peer Reviews and RCA processes. 

• Data Analysis is performed by this position with Incident Report Surveys presented to the State, County, and Providers Leadership Team.

Policies, Procedures and Contract Administration

• Review and monitor annual/as-needed updates to Division policies and procedures. 

• Assure that policies and procedures are in compliance with any CMS, Federal, State rules and regulations and contract provisions. 

• Coordinate with Division Managers to address any programmatic changes to policies and procedures. 

• Advise senior management on policy and organizational issues with contract process and make recommendations for process improvement. 

• Identify problems and formulate solutions independently or through consensus with stakeholders; provide project management on inter-divisional contract projects; consult with programs in BHD to assist with their development and implementation of training for revised or new business systems or processes. 

• Contract citation and boilerplate content oversight over site for all contracts and amendments. 

• Review/revise boilerplates against guiding contracts (CFAC, CCO, and grants) and regulations annually.

Risk Assessments, Investigations and Audits

• Develop, implement, and maintain BHD Compliance Plan, quality management plans and systems to ensure compliance and achieve program outcomes. 

• Conduct Risk Assessments and internal Audits of BHD programs when issues arise, or on a predetermined schedule per Compliance Plan. 

• Review mental health treatment records and conduct interviews. 

• Compile and analyze all investigative findings in order to reach a conclusion regarding allegations. 

• Write detailed investigative reports summarizing findings and supporting conclusions and recommendations for corrective action by mental health providers. 

• These reports range from the initial notification and brief description of allegations, through a comprehensive report of investigation and witness interviews needed to reach a conclusion and required actions. 

• Provide technical assistance when needed. 

• Monitor for compliance with any required action. 

• Participate in Behavioral Health compliance audits and quality assurance reviews. 

• Conduct investigations of fraud, waste and abuse allegations and code of conduct reports as needed. 

• Perform regular prospective and retrospective audits of Behavioral Health Direct Clinical Services claims. 

• Coordinate collection of overpayment when indicated.

TO QUALIFY:

We will consider any combination of relevant work experience, volunteering, education, and transferable skills as qualifying unless an item or section is labeled required. Please be clear and specific about how your background is relevant. For details about how we typically screen applications, review our overview of page.

Required Minimum Qualifications:

Education/Certification: Must have a Masters degree and must meet the standards of Qualified Mental Health Professional - R (QMHP-R) with the Mental Health & Addiction Certification Board of Oregon (MHACBO). Please visit the MHACBO website to confirm your eligibility to apply; AND

Experience: Five (5) years of increasingly responsible and major program development, policy analysis, or program compliance/monitoring and evaluation experience.

Knowledge, Skills and Abilities (KSA): 

• Any working knowledge of contract compliance criteria and quality indicators. 

• Any experience in conducting audits or investigations, including data collection, analysis, recommendations for corrective action and compliance monitoring. 

• Experience with Medicaid billing, managed care systems, and/or health plans.

Other:  

• This position requires a Background Investigation, which may include being fingerprinted. 

• Completion of Healthcare Basic Compliance Academy within 1st year in the position

Preferred Qualifications/Transferable Skills*: You do not need to have the following preferred qualifications/ transferable skills to qualify. However, keep in mind we may consider some or all of the following when identifying the most qualified candidates.

• Certified in Healthcare Compliance (CHC)

• Lead with race through actions and advocacy with internal programs, with community partners and across departments throughout the county.

• Demonstrate the ability to flex style when faced with myriad dimensions of culture in order to be effective across cultural context.  

• Respect and appreciation for ethnic and cultural diversity.

• Ability to collaborate and build relationships to achieve positive work outcomes.

• Ability to maintain a safe and healthful workplace.

• High degree of resilience, is outcome driven and can thrive in an environment of rapid change while effectively managing pressure in an effective and professional manner.

• Experience working in healthcare compliance

• Experience working in the behavioral health field

*Transferable skills: Your transferable skills are any skills you have gained through education, work experience (including the military) or life experience that are relevant for this position. Be sure to describe any transferable skills on your application and clearly explain how they apply to this position.

SCREENING & EVALUATION (REQUIRED): 

The Application Packet: You must submit ALL requested items below. Failure to do so will be deemed as an incomplete application.

1. Attach a Resume demonstrating you meeting minimum qualifications; AND

2. Attach a Cover Letter addressing the following: 

• How you meet the qualifications for this position, including your current certifications; and 

• Why you are interested in the position

3. Attach a copy of your (Required): Oregon QMHP-R Certification

Note: The application, resume and cover letter should demonstrate your work experience/skills and how it is related to those shown in the ‘Overview’ and ‘To Qualify’ sections of the job announcement. Please be thorough, as these materials will be scored and determine your eligibility to advance in this recruitment process. 

The Selection Process: For details about how we typically screen applications, review our page. We expect to evaluate candidates for this recruitment as follows:

• Initial review of minimum qualifications

• An evaluation of application materials to identify the most qualified candidates

• Consideration of top candidates/interviews

• Background, reference, and education checks

Note: Application information may be used throughout the entire selection process. This process is subject to change without notice.

ADDITIONAL INFORMATION:

Type of Position: This represented position is eligible for overtime

Type: Represented

FLSA: Non-exempt 

Note: The eligible list created from this recruitment may be used to fill regular, full or part time, temporary, and limited duration assignments.

Salary/Pay: Please be advised that the pay range listed for this position is intended to provide general guidance on the earning potential for the role. However, actual compensation will be determined in accordance with the Oregon Equal Pay Law and will take into account factors such as the candidate's relevant experience and education. Candidates should expect that initial offers will be made within the listed pay range and may not be at or near the top of the range.

Our Commitment to Safety, Trust and Belonging: Multnomah County is committed to developing, nurturing and continually improving workforce equity by identifying and addressing the structural and policy barriers to equal employment opportunity faced by our employees and communities. County employees across the organization have stepped forward to develop a strategic plan and help create a workplace where everyone can reach their