Clinical Quality Specialist

About Upheal

We’re on a mission to help mental health professionals find better balance. Our therapy-focused AI automates tasks, captures insights, and tracks outcomes for healthier clients. We're committed to privacy, reducing burnout, strengthening connections, and boosting incomes.

Job Summary

The Clinical Quality Specialist will be responsible for ensuring the accuracy, compliance, and relevance of AI-generated documentation. You’ll design and implement quality assurance processes, conduct regular audits, and ensure adherence to healthcare and payer requirements.

Key Responsibilities

1. Quality Assurance & Compliance
   • Develop, implement, and refine QA processes to ensure the accuracy, completeness, and compliance of AI-generated documentation.
   • Conduct regular audits on AI-generated notes to verify adherence to clinical documentation standards, including ICD-10 and DSM-5 coding accuracy.
   • Identify discrepancies or errors in AI-generated documentation, providing actionable feedback to improve accuracy.
2. Collaboration and Feedback
   • Work closely with AI development and product teams to provide clinical expertise and feedback on AI functionality, with a focus on mental health concepts, regulatory standards, and insurance compliance.
   • Participate in testing and validating new AI model features to improve mental health documentation quality.
   • Offer guidance to other team members on best practices in clinical documentation and insurance coding requirements etc.

Minimum Requirements

• Licensure and Experience: Licensed Mental Health Professional (e.g., LCSW, LMFT, LPC, or Psychologist) with 3+ years in clinical documentation, quality assurance, and payer requirements within mental health or healthcare.
• Technical and Industry Skills: Proficient in ICD-10 and DSM-5 coding, EHRs, and HIPAA compliance
• Insurance and Compliance Knowledge: Familiarity with insurance documentation and reimbursement standards
• Attention to Detail and Communication: Strong attention to detail, ability to identify documentation inconsistencies, and effective communication skills for cross-functional collaboration and feedback on AI-generated content.

Preferred Qualifications

• Professional Certifications: Certification in coding (e.g., Certified Professional Coder - CPC) or clinical documentation improvement (e.g., Certified Clinical Documentation Specialist - CCDS), Certified Healthcare Compliance (CHC)
• Knowledge of QA methodologies and AI or healthcare technology
• Experience in a mental health tech startup environment or affinity for fast paced environments