UR Treatment Plan Quality Assurance Specialist

Exact Billing Solutions
US - Florida - Florida
January 19, 2025

Brief Description

UR Treatment Plan Quality Assurance Specialist (BCBA) - Exact Billing Solutions

Lauderdale Lakes, FL

About Exact Billing Solutions

Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental health, and autism fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies.

Key Opportunity - New Role for BCBA!

If you're a BCBA or behavioral health/psychology professional looking for a new challenge, you'll want to consider this exciting opportunity!

Our Utilization Review Treatment Plan Quality Assurance professional is responsible for ensuring the quality, effectiveness, and compliance of treatment plans in Applied Behavior Analysis (ABA) programs. This role involves reviewing patient treatment plans and clinical rationales and assessing their alignment with best practices, regulatory requirements, and clinical guidelines. The position supports the optimization of resources, maintains documentation integrity, and ensures the highest standards of care are met for individuals receiving ABA therapy.

What You'll Do

Review Treatment Plans/Clinical Rationale: Assess the quality and accuracy of ABA treatment plans, ensuring that they are developed in accordance with clinical guidelines, patient needs, and evidence-based practices.
Compliance Monitoring: Ensure that treatment plans comply with state, federal, and accreditation body regulations, including insurance requirements for ABA services.
Utilization Review: Conduct utilization reviews to determine the necessity, appropriateness, and efficiency of ABA therapy services provided. Ensure that services align with authorized treatment hours and goals.
Documentation and Reporting: Maintain accurate and up-to-date records of treatment plan reviews and findings. Provide feedback and suggestions for improvement based on quality assessments.
Collaboration with Clinical Teams: Work closely with behavior analysts, clinicians, and other healthcare professionals to ensure treatment plans are appropriately tailored to individual clients' needs and goals.
Quality Improvement Initiatives: Contribute to continuous quality improvement initiatives by analyzing treatment plan trends, identifying gaps in services, and suggesting modifications to improve care outcomes.
Stakeholder Communication: Communicate effectively with parents, caregivers, and other stakeholders to ensure transparency and understanding of treatment plan revisions, goals, and outcomes.
Training and Education: Provide education and support to clinical staff regarding treatment plan development, documentation requirements, and quality assurance standards.
Case Review and Auditing: Participate in periodic audits of treatment plans and therapy services to identify areas of improvement and ensure adherence to internal and external quality standards.

Requirements

Education/Experience and Other Requirements

Bachelor's or Master's degree in Behavioral Health, Psychology, Social Work, or related field (or equivalent experience).
Certifications:

Board Certified Behavior Analyst (BCBA) preferred.
Additional certifications in Utilization Review or Quality Assurance are a plus.

Minimum of 2-3 years of experience in Applied Behavior Analysis (ABA) therapy or related clinical field.
Experience in utilization review, quality assurance, or case management is highly desirable.
Willingness to submit to drug and background screenings.

Expertise Needed

Strong understanding of ABA principles, clinical practices, and therapeutic techniques.
Knowledge of insurance requirements, clinical documentation standards, and healthcare regulations.
Excellent analytical, organizational, and problem-solving skills.
Strong communication skills for interaction with clinical teams, families, and other stakeholders.

Summary

Benefits

Three weeks of paid time off in first year (more added with tenure)
Medical, dental, vision, long-term disability, and life insurance
Flexible Spending Account (FSA) and Health Savings Account (HSA) options
Generous 401(k) with employer match up to 6%

Exact Billing Solutions Culture

Integrity. Dependability. Attention to detail. All our team members exhibit these qualities when it comes to doing business. And when it comes to the business of supporting a team, as a company, we offer no less to our team members. We're a fast-paced, growing company delivering services that allow our clients to spend more time helping people. At the end of the day, it's people, not numbers, that drive our success.

Recruiter ID:

Exact Billing Solutions participates in the U.S. Department of Homeland Security E-Verify program

Read the full job description and apply online on the recuiter's web-site

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