ERG II LLC

Job Description - Quality Assurance Specialist

Position Title:

Quality Assurance Specialist

Employment Status:

Full-Time

Work Location:

Primarily Remote Position

This position is primarily remote; however, occasional travel may be required during the onboarding process and throughout employment to assist with staff training, quality assurance reviews, audits, and operational support.

Position Summary

The Quality Assurance Specialist works collaboratively with the Director of Quality Assurance, Vice President of Compliance and Operations, Utilization Review Department, Clinical Leadership, and Program Staff to ensure clinical and operational compliance across all programs. Responsibilities include program development and implementation, extensive quantitative and qualitative chart auditing, training staff on medical necessity and documentation standards, maintenance of policies and procedures, verification of billing documentation, and ensuring compliance with all applicable state, federal, accreditation, and regulatory requirements.

The Quality Assurance Specialist plays a critical role in maintaining the integrity of client records, ensuring accurate documentation, supporting revenue cycle processes, and promoting compliance with organizational standards and regulatory requirements.

Essential Job Responsibilities

Clinical DocumentationChart Auditing

• Conduct comprehensive qualitative and quantitative chart audits to ensure compliance with organizational, payer, and regulatory requirements.

• Audit clinical documentation to verify accuracy, completeness, timeliness, and compliance.

• Monitor client charts daily to ensure all documentation supports the appropriate level of care and medical necessity.

• Follow up with staff regarding deficiencies identified during audits and ensure corrective actions are completed within established timeframes.

• Maintain audit records, corrective action plans, and compliance reports.

ComplianceQuality Assurance

• Develop, implement, and maintain quality assurance systems and checks-and-balances tools to ensure chart compliance.

• Ensure services provided comply with:

  • HIPAA regulations

  • 42 CFR Part 2 requirements

  • Joint Commission standards

  • CARF standards

  • ADP requirements

  • State and Federal regulations

  • Insurance and payer documentation requirements

• Assist with policy and procedure development, review, and maintenance.

• Identify compliance risks and recommend corrective actions and process improvements.

TrainingStaff Development

• Assist with training and education of Clinical and Support Staff regarding:

  • Medical necessity documentation

  • Clinical documentation requirements

  • Regulatory compliance standards

  • Quality assurance processes

• Collaborate with Clinical Directors and Leadership Teams to provide coaching and documentation support.

• Participate in onboarding and ongoing staff education initiatives as assigned.

Utilization ReviewBilling Support

• Collaborate with the Utilization Review Department to ensure timely completion of clinical documentation.

• Work with billing departments and contracted billing companies to verify documentation required for claims submission.

• Ensure documentation supports services billed and complies with payer requirements.

• Assist in resolving documentation-related billing issues.

Additional Duties

• Participate in program development and quality improvement initiatives.

• Assist with regulatory audits, accreditation surveys, and compliance reviews.

• Prepare reports and compliance metrics as requested.

• Perform other duties as assigned by the Director of Quality Assurance, Vice President of Compliance and Operations, Clinical Director, or Executive Leadership.

Required SkillsQualifications

EducationExperience

• Experience in behavioral health, substance use disorder treatment, mental health services, quality assurance, utilization review, or compliance preferred.

KnowledgeCompetencies

• Advanced knowledge of the 12-Step treatment model and its application in residential treatment settings.

• Knowledge of process addictions and available treatment resources.

• Understanding of dual-diagnosis treatment practices and non-pharmacological symptom management techniques.

• Advanced knowledge of HIPAA and 42 CFR Part 2 regulations.

• Knowledge of medical necessity requirements and clinical documentation standards.

• Familiarity with Joint Commission, CARF, and other accreditation standards.

• Strong analytical, organizational, and problem-solving skills.

• Excellent written and verbal communication skills.

• Ability to work independently while maintaining collaboration with multidisciplinary teams.

• Proficiency in electronic health record systems and Microsoft Office applications.

CertificationsRequirements

• Current First Aid/CPR Certification.

• Health Screening Clearance.

• Ability to travel occasionally as required.

Position Relationships

Supervised By:
Director of Quality Assurance

Promotion From:
N/A

Workers Supervised:
N/A

Performance Expectations

The employee will receive periodic performance evaluations measuring quality, productivity, compliance, communication, teamwork, and overall job performance.

Failure to meet performance expectations may result in the implementation of a Performance Improvement Plan (PIP) with specific goals and timelines for improvement. Continued failure to meet performance expectations may result in progressive disciplinary action, up to and including termination of employment.

Equal Employment Opportunity Statement

ERG II LLC is committed to providing Equal Employment Opportunities to all employees and applicants. Employment decisions are made without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, disability, veteran status, or any other protected characteristic under applicable federal, state, or local laws.

Acknowledgment

I have read my position description and it has been explained to me by my supervisor. I understand my job functions and responsibilities and agree to perform all duties as outlined herein and any additional duties assigned by management.

Employee Name: _____________________________________

Date: _______________________

Employee Signature: _____________________________________

Date: _______________________