Quality & Compliance Monitoring Coordinator

About the role

Responsible for conducting routine monitoring activities to support documentation accuracy, billing compliance, and adherence to agency requirements. Reviews monitoring reports, follows up on identified issues, and assists with necessary corrections. Provides administrative and operational support for designated therapy programs, including referrals, authorizations, episode management, discharge processing, caseload monitoring, and other utilization management functions. Provides backup coverage for the Clinical Care Coordinator position, including client contact and triage of therapy referrals, as needed.

Responsibilities

• Runs monitoring reports in accordance with the agency’s annual audit plan to identify potential documentation and billing errors.
• Reviews identified issues, follows up with staff as needed, and completes or facilitates necessary corrections.
• Assists the Compliance Team with processing requests for corrections or changes to clinical documentation and billing records.
• Monitors caseloads for Youth, School-Based, and contract therapists to identify missing or untimely documentation and follows up with therapists and/or appropriate staff as needed.
• Processes referrals to the TAP program and completes required documentation and system entries.
• Opens therapy episodes and enters required authorizations for Youth and School-Based Therapy services.
• Processes therapy discharges for Youth, School-Based, and contract therapy services, including completion of required system updates.
• Receives requests for reauthorization. Reviews clinical documentation and prepares information for the Utilization Management (UM) Panel. Serves as chairperson of the UM Panel, presents cases for review, and completes reauthorization approval based on the Panel’s determination.
• Updates and maintains applicable therapy provider information and lists.