Substance Use Disorder And Mental Health Quality Clinical Documentation Professional

Sunshine Behavioral Health is committed to delivering the highest quality substance abuse treatment services with passion, integrity, and a strong sense of purpose. Guided by shared values, we inspire hope and aim to uplift the health and well-being of the communities we serve. Our approach centers on continuous improvement and providing compassionate care to those in need.

The Revenue Cycle Quality Documentation and Support Specialist is responsible for ensuring the accuracy, consistency, and quality of medical documentation across all facilities within Sunshine Behavioral Health. This role includes conducting comprehensive chart audits, developing training materials, enhancing compliance processes, and collaborating with various departments to meet regulatory guidelines and improve the overall quality of medical and clinical documentation. The position requires strong knowledge of LOCUS and ASAM criteria, as well as experience with utilization review and revenue cycle management.

• Conduct daily medical completion audits across all facilities to ensure documentation accuracy and compliance.
• Review charts for Medical, Completion, and Quality to maintain high best practice guidelines and standards of documentation.
• Provide feedback and recommendations for improvement to departments based on audit findings.
• Consistently update and enhance completion and quality matrices to align with payor guidelines.
• Creating the proactive ability to adapt to upcoming changes within payor structures and guidelines with ASAM, LOCUS, Inter Qual, ABA, MCG, TAC guidelines and more.

• Monitor and track issues identified during audits and collaborate with relevant departments to address them.
• Support departments with outstanding audit feedback and communication to improve compliance and quality.
• Evaluate RCM supervisors internal reporting performance opportunities, issues, and educational needs to improve (Benefits, Authorizations, claim submission, Claim follow up, and Payment posting) to help assist and hold stakeholder accountable in integrity improvements with our payors.

• Assist and Generate Billing on Hold - Pending Authorization and UR Audit Monthly Reports and feedback to enhance education improvements in the UR department and enhancement in medical record and external audits.
• Assist and prepare biweekly completion and quality reports for each facility and deliver findings to relevant stakeholders.
• Holding Provider Vendor and Facilities accountable for weekly provider follow-up session within Residential and PHP treatments to shield company from external performance audits, credentialing, and contracting obligations to void claw backs and other identified risks.

• Assist, develop, update, and revise Standard Operating Procedures (SOPs) and training materials for medical records enhancement (across facility departments: compliance, medical, nursing, operations, clinical, and within standard Quality Audit Dept)
• Assist in development and creating improvement-focused educational documentation platforms to support department training.
• Assist and conduct training sessions virtually or on-site (boots on the ground) to ensure staff comprehension and adherence to protocols.

• Coordinate with Medical Records, Utilization Review (UR), and Facility departments to address documentation needs.
• Serve as an advocacy and support to the liaison between departments to ensure seamless communication and feedback.

• Participate in the Documentation Quality Enhancement Project aimed at improving medical record accuracy and consistency.
• Work with departments to develop processes that align with regulatory requirements and enhance compliance.
• Assist in performing monthly write-offs (W/O) auditing and reporting to RCM leadership to assist with billing opportunities, issues, and both internal and external audits of revenue losses.

• Completes other duties assigned by VP Revenue and Data Strategy and RCM Quality Documentation Liaison.
• Provides input to department training and level up policies and procedures.
• Assesses and communicates staff development needs to the RCM department managers and Director
• On occasion may assist with the training of staff based on trends identified.
• Retraining and assisting in Utilization review management (SUD/MH)
• Retraining to be up to date with UR changes and experiences with Auditing the UR team
• Assisting with support and training new UR members and enhance their growth and improvement in written and verbal platforms to help with client advocacy and medical records support for continued care within treatment.
• Assist and support with UR team if needed due to staffing and high census