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Employer: Sedgwick County
Job Title: Utilization and Compliance Review Specialist | Admin/Operations
Salary: $40145.59 Annually
Veterans' Preference is available for this vacancy.
To receive Veterans' Preference, you must supply a copy of your DD214 to the Human Resources department at Sedgwick County after applying.
Usual working days/hours:
Monday - Friday | 8:00 AM - 5:00 PM
Location of work:
934 N. Water | Wichita, KS
Highly visible and diverse position responsible for assisting the Director of Quality, Risk Management, Compliance and Innovation with the ongoing development and implementation of the agency quality, risk management and compliance plans and innovation activities. Specifically, this position is responsible for performing retrospective reviews of medical records of patients to ensure proper utilization of treatment resources, compliance with documentation guidelines and medical necessity in relation to federal and state regulations. Also responsible for auditing patient records to monitor accuracy of billing and the identification of potential overpayments from Medicaid and Medicare, as well as tracking utilization and compliance data. Responsible for helping to identify internal training needs relevant to scope of responsibility and the development of educational curriculum to assist staff with being better positioned to do their work effectively, efficiently and with a focus on quality and outcomes. Also assists in providing consultation to members of COMCARE’s leadership team as well as all COMCARE programs. Is routinely involved in the development of COMCARE’s annual Quality, Risk Management and Compliance work plans to include participation in independent investigations of suspected misconduct, abuse or fraud. Also participates in quality improvement and innovation projects.
Essential Job Functions:
30% Performs utilization and compliance review activities to comply with state and federal mandates
• Performs retrospective record reviews and audits with a focus on quality and risk indicators as it relates to utilization of resources, documentation guidelines, contractual obligations, compliance and medical necessity.
• Compiles detailed reports and recommendations to the Director of Quality, Risk Management, Compliance and Innovation, Executive Director and other managers.
• Through reviews, identifies trends, areas of risk and areas for improvement.
• Provides leadership and direction to senior management, supervisors, provider staff and business partner agencies regarding regulatory requirements
• Assists the Director of Quality, Risk Management, Compliance and Innovation with investigating any reports of suspected fraud or abuse concerning billing or documentation of services.
• Generates agency documentation of utilization and compliance review activities
• Assists the Director of Quality, Risk Management and Compliance with responding to external auditors and onsite reviewers during site visits. 05% Provides support and coaching to Beating the Blues participants
• Responds to calls or emails regarding Beating the Blues.
• Orients new participants to Beating the Blues.
• Provides coaching and support to participants of Beating the Blues. 30% Consultation and Education
• Assists in identifying education needs related to clinical documentation for COMCARE and business partners.
• Develops and delivers training.
• Primary contact for questions and consultation by provider staff and managers related to compliance, documentation, agency standards, polices, etc.
• Assists Director of Quality, Risk Management, Compliance and Innovation with special trainings pursuant to agency need.
• Assist staff with utilizing Essential Learning and development of course content as warranted. 20% Quality and Risk Management Activities
• Participates in Quality/Risk Management and Compliance Oversight Committee.
• Leads and participates in quality improvement work groups.
• Assists with agency satisfaction surveys.
• Collects, analyzes and trends complex data. 15% Innovation projects
• Assists in the identification and implementation of new initiatives or innovative practices.
• Assists in the identification, tracking, trending and reporting of outcome measures. • Assists in testing new releases of PsychConsult.
• Provide assistance to programs as warranted.
• Helps develop and maintain data reports that assist in telling the agency story.
• Assist in determining and executing focus groups as appropriate.
• Must possess a Master's Degree in a Human Service field and hold BSRB licensure in Kansas or be license eligible
• Must possess strong teaching and coaching skills
• Must have demonstrated experience understanding systems and the interdependence of work functions.
• Candidate must also have working knowledge of quality improvement principles and compliance and have the ability to understand and apply applicable state and federal regulations related to mental health, substance abuse, HIPAA and corporate compliance.
• In addition to strong communication skills, must possess strong writing and presentation skills.
• Must possess a minimum of three (3) years experience in mental health and/or a combination of experience in mental health/substance abuse.
• Prefer candidate with demonstrated experience with collaborative leadership and working within teams, as well as comfort working with all levels of the organization.
• Must be able to use or quickly learn different software applications.
•Interest and ability to fully understand functionality of our electronic health record.
• Interest and ability to fully understand functionality of our electronic health record. Physical demands:
• Frequently sits at desk and operates computer.
• Must be able to drive as does require some travel between program locations and occasional transportation to off-site activities.
• Background checks including but not limited to KBI and DCF adult and child abuse registry.
• Motor vehicle screening
• Pre-employment drug screen
Modern office equipment PsychConsult
• Office based position - located within our Administrative Office.
• Occasional in-town travel to our other COMCARE facilities and affiliate/contract provider facilities.
*This position may be filled or closed to further application without notice.*
It is the policy of Sedgwick County not to discriminate in its programs or services provided to the general public, including employment and all other activities, on the basis of race, color, religion, national origin, citizenship, sex, age, disability, veteran status or any other similarly protected status. Sedgwick County is committed to making the application, interview, and pre-employment testing process accessible to persons with disabilities. If you wish to volunteer information regarding any special assistance you may need, please notify Crissy Magee, Sedgwick County ADA Coordinator by phone (316) 660-7056, TDD (Kansas Relay at 711 or 800-766-3777), or email at firstname.lastname@example.org
. Do not send resumes or application status request or employment questions to this email or phone number. This information is provided only for those requiring ADA assistance. Applications must be submitted on www.hrepartners.com. You will be contacted should the department feel that you are a qualified candidate.
Sedgwick County will prohibit the hiring of spouses and/or immediate family members within the same department, but not within the County structure.
Immediate family and family of the employee’s spouse shall be considered husband, wife, son, step-son, son-in-law, daughter, step-daughter, daughter-in law, brother, step-brother, brother-in law, sister, step-sister, sister-in-law, mother, step-mother, mother-in law, father, step-father, father-in-law, grandchildren, grandparents and grandparents-in-law.
3/7/2017 12:00:00 AM
6/5/2017 11:59:59 PM