Compliance and Billing Specialist - R-18060

PLEASE APPLY HERE: https://multco.wd1.myworkdayjobs.com/Multco_Jobs/job/Portland-OR/Compliance-and-Billing-Specialist_R-18060

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. In addition to providing complex technical assistance and direction with financial issues (authorization and claims), this position works with senior staff and leadership in Quality Management, Clinical Programs, and Finance to develop process and training materials, set Billing program goals and objectives, evaluate and assess changes in state, federal and funding requirements and laws, provide program workload and improvements, attend external committee meetings as the program representative and voice, and assure Continuous Quality Improvement (CQI) is an on-going factor within these program areas. Direct Clinical Services (DCS) is a revenue generating program for the Behavioral Health Division (BHD) and this position is essential for the financial and operating health of BHD.

As the Compliance and Billing Specialist, 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 services. 

• Be the clinical consultant for the Quality Management Compliance team on any matter that requires a QMHP or licensed staff lens, including, but not limited to, Oregon Administrative Rules (OAR), Oregon Health Authority (OHA), Coordinated Care Organization (CCO), state and federal law interpretation, and policy and procedures. 

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

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

• 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 involved teams. 

• Assist BHD Quality Management and leadership teams with tracking OHA Rule Advisory Committee meetings and provide engagement with rule changes, 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.

Clinical Billing Support, Training, Oversight, and Technical Assistance

• This position manages training and supporting billable services provided by Direct Clinical Services staff. 

• This may include training staff on clinical documentation, billing codes, and clinical procedures. 

• This position monitors and enforces program compliance with local, state and federal requirements, OARs, Oregon Revised Statutes (ORS) and Medicaid payment rules through service reports, extracting claim denial information and billing batch adjudication. 

• This position tracks billing trends and makes process evaluations and recommendations based on data to leadership where training or changes in process or documentation is needed or required based on legal or best practices needs. 

• Develop general and specialized technical reports, spreadsheets and documents for use in program review, evaluation, development and improvements, and in communication with and to division leadership. 

• This position identifies and supports ways to increase billable revenue for the Division. 

• This position works in conjunction with the Finance team to collect billing information and data to evaluate against Medicaid billing rules and the CCO contract to ensure compliance. 

• This position conducts data evaluation and analysis that aids in detection of Fraud, Waste and Abuse risk areas. 

Policies, Procedures and Contract Administration

• Assure that policies and procedures are in compliance with any Centers for Medicare and Medicaid Services (CMS), Federal, State rules and regulations and contract provisions. 

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

• Provide technical assistance when needed.

•  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 (Consumer and Family Advisory Committee (CFAC), CCO, and grants) and regulations annually. 

• Plan and develop Billing Program program descriptions, policies, procedures, and systems with subject matter expertise in authorizations, claims and payment for Direct Clinical Services Medicaid billing. 

• Position works with Quality Management staff, Senior Leaders, Operations Manager, DCS program staff and Billing Support program staff to draft documentation; review with all stakeholders, incorporate feedback and finalize operational details of the program. 

• Position monitors the end-to-end Billing process, and reports findings to Quality Management staff, Senior Leaders, Operations Manager, DCS program staff, and Finance team, providing business analysis and consultation. 

• Position recommends policy goals and objectives for the Billing Program, interprets and develops policies and operational procedures, assures compliance; monitors non-compliance and follows up with Decision Support Manager, DCS Senior Manager, Quality Manager and Finance Manager on issues as they arise. 

• This position leads billing committees/subcommittees, and represents the Billing Program in relevant billing meetings.

Minimum Qualifications (REQUIRED): 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. This position requires a QMHP-R within 30 days of hire and/or licensed Board of Oregon (LPC, LCSW, CSWA, PhD, etc.) AND

• Masters degree in psychology or

• Masters degree in social work or counseling or

• Masters degree in a behavioral science field

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. 

• Compliance or billing experience within the Behavioral Health field

• Leads 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.

• Knowledge of challenges and barriers faced by those with Severe and Persistent Mental Illness (SPMI) and the systems they encounter in Residential Services, Adult Protective Services and Crisis Services.  

• 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.

Questions? Contact recruiter: Caitrin Thomaselli, email: [email protected], phone: (971) 421-8257