Clinical Quality Assurance Specialist
Location
United States
Posted
32 days ago
Salary
$75K - $98K / year
Seniority
Mid Level
Job Description
Clinical Quality Assurance Specialist
BetterHelp
• Conduct thorough clinical chart audits to ensure compliance with BetterHelp's clinical standards of practice and evidence-based treatment protocols • Review patient documentation for accuracy, completeness, and adherence to regulatory requirements and insurance coverage criteria • Evaluate treatment planning, progress notes, and clinical decision-making against established clinical guidelines and best practices • Identify patterns of clinical excellence and areas for improvement in documentation and care delivery • Maintain detailed audit findings and recommendations in compliance with quality assurance protocols • Support the day-to-day operations of the quality assurance team, including audit scheduling, tracking, and reporting • Participate in preparing necessary documentation for insurance audits. Download the requested patient records and policies & procedures. • Collaborate with clinical teams to address audit findings and implement corrective action plans • Assist in developing and refining clinical audit tools, checklists, and evaluation criteria • Contribute to quality assurance training materials and educational resources for clinical staff • Participate in quality improvement initiatives based on audit findings and clinical trends • Ensure all clinical chart reviews meet insurance payer requirements and regulatory standards • Monitor compliance with state licensing requirements, professional practice standards, and accreditation criteria • Support preparation for external audits and regulatory reviews by maintaining comprehensive documentation • Stay current with evolving insurance requirements and clinical practice standards that impact quality assurance processes • Collaborate with compliance teams to address any regulatory or contractual requirements identified through audit processes
Job Requirements
- Master's or Doctoral degree in psychology, clinical social work, counseling, psychiatry, or closely related mental health field
- Current, active clinical license in good standing (LCSW, LPC, LMFT, PsyD, PhD, MD, or equivalent)
- Minimum 2+ years of clinical practice experience with direct patient care and clinical documentation
- Strong understanding of evidence-based mental health treatment practices and clinical documentation standards
- Exceptional attention to detail with ability to identify discrepancies and areas for improvement in clinical records
- Experience with electronic health records (EHR) systems and clinical documentation platforms
- Excellent written and verbal communication skills with ability to provide constructive feedback to clinical colleagues.
- Experience with clinical auditing, quality assurance, or utilization review in healthcare settings
- Knowledge of insurance requirements, medical necessity criteria, and value-based care standards
- Background in virtual care delivery or digital health platforms
- Familiarity with regulatory requirements for mental health services and clinical documentation
- Experience working with diverse clinical teams and providing clinical supervision or consultation
Benefits
- Remote work with regular in-person bonding experiences sponsored by the company
- Competitive compensation
- Holistic perks program (including free therapy, employee wellness, and more)
- Excellent health, dental, and vision coverage
- 401k benefits with employer matching contribution
- The chance to build something that changes lives – and that people love
- Any piece of hardware or software that will make you happy and productive
- An awesome community of co-workers
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