Position Summary
The Quality Assurance & Compliance Coordinator is responsible for ensuring that Synergy Recovery Institute LLC remains fully compliant with all applicable federal, District of Columbia, payer, and organizational requirements. This role oversees documentation quality, regulatory compliance, provider credentialing oversight, policy management, HIPAA compliance, and continuous quality improvement to maintain an audit-ready practice at all times.
Primary Responsibilities
Clinical Documentation Review
- Audit 100% of new clinicians' charts during onboarding and a representative sample of ongoing charts thereafter.
- Review psychotherapy notes for completeness and compliance.
- Verify treatment plans are current.
- Ensure assessments are completed timely.
- Confirm informed consent forms are signed.
- Verify diagnosis documentation supports billed services.
- Ensure medical necessity is documented.
- Return charts requiring corrections before claims are finalized, when operationally feasible
Regulatory Compliance
Maintain compliance with:
- HIPAA
- DC Department of Behavioral Health requirements (as applicable)
- DC Medicaid
- Medicare (if applicable)
- Commercial payer requirements
- Corporate compliance policies
Credentialing Oversight
Monitor:
- Professional licenses
- NPI records
- CAQH profiles
- Malpractice insurance
- DEA registration (when applicable)
- CPR certification (if applicable)
- Background checks
- Required training
- Recredentialing deadlines
HIPAA Compliance
Maintain:
- Business Associate Agreements
- HIPAA training logs
- Incident reports
- Privacy documentation
- Security risk assessments
- Confidentiality acknowledgments
Quality Improvement (QI)
Develop and maintain:
- Monthly chart audit reports
- Documentation quality scorecards
- Corrective action plans
- Provider performance trends
- Compliance dashboards
Policy & Procedure Management
Review and update:
- Employee Handbook
- Clinical Policies
- Compliance Manual
- Emergency Procedures
- Infection Control
- Telehealth Policies
- Documentation Standards
Risk Management
Monitor:
- Patient complaints
- Critical incidents
- Sentinel events
- No-show trends
- Documentation deficiencies
- Potential compliance risks
Audit Preparation
Maintain an Audit Readiness Binder (electronic and/or physical) that includes:
- Organizational licenses
- Business licenses
- Insurance certificates
- Provider credentials
- Policy manuals
- Staff training records
- QA reports
- HIPAA documentation
- Credentialing files
- Compliance logs
- Corrective action plans
The goal is to be able to produce requested documentation promptly if a payer or regulator initiates an audit.
Weekly Responsibilities
- Audit clinical documentation.
- Review provider compliance.
- Verify treatment plans.
- Track corrective actions.
- Monitor credentialing deadlines.
- Meet with the Director.
- Submit a weekly Compliance Report.
Monthly Responsibilities
- Conduct Quality Improvement meetings.
- Review KPIs.
- Audit HIPAA compliance.
- Update the compliance dashboard.
- Review incident reports.
- Verify provider files.
- Prepare an executive summary.
Quarterly Responsibilities
- Complete internal compliance audits.
- Review all organizational policies.
- Conduct staff compliance training.
- Perform a mock payer audit.
- Perform a HIPAA self-assessment.
- Present findings to leadership.
Qualifications
Preferred candidates will have:
- Bachelor's degree in Healthcare Administration, Nursing, Public Health, Social Work, or a related field.
- At least 2 years of experience in behavioral health or healthcare compliance.
- Working knowledge of HIPAA, Medicaid, payer documentation requirements, and electronic health records.
- Strong organizational and communication skills.
Pay: $32.00 - $38.00 per hour
Work Location: In person
