Records Reviewer/ QI Specialist

Company: Seacoast Mental Health Center
Location: Portsmouth
Posted on: April 2, 2026

Job Description:

If you are interested in a rewarding job and a supportive culture, as well as being part of an organization that rates the highest in the state for consumer satisfaction, Seacoast Mental Health Center, Inc. has an opening for a (on-site) Records Reviewer/ QI Specialist to join our team! At Seacoast Mental Health Center, we provide hope and promote recovery for children, adolescents, adults and their families in the Eastern half of Rockingham County. The rising demand for mental health and substance use disorder services offers immediate employment opportunities Educational/Experience Requirements: BA/BS or MA/MS/MSW in Human Services or related field, at least 2 years’ experience in a Community Mental Health Center, mental health or other health care setting or experience relative to expectations of the position. Direct care, clinical experience, and/or experience with behavioral health documentation preferred Tasks: 1. Review clinical records and documentation from all departments for compliance, completeness, accuracy and timeliness. Review activities include but are not limited to random or focused reviews, qualitative documentation reviews, follow up to committee projects, mileage reviews, and reviews at the request of the CEO, VP of Quality and Compliance (VP-QC), Compliance Officer, VPs of Clinical Operations, and/or Clinical Managers. a. Review the clinical documentation of newly hired staff to assure the staff members’ understanding of the services being provided and the documentation requirements associated with each service, b. Review clinical cases upon notice of staff termination or transfer within the agency. Monitor and follow up caseloads until paperwork is complete and c cases are transferred or closed, c. Maintain a database of audits completed and sent to staff. Maintain staff files including reviews, issues discussed, and relevant correspondence, d. Notify staff of actions needed and track compliance with corrective action requests, involving supervisors as needed. 2. The Records Reviewer performs financial audits to assure compliant and accurate documentation and timely reimbursement for services rendered. Financial audits are conducted by reviewing clinical records and evaluating documentation contained therein against data in the Information System. Evaluation includes but is not limited to assessment of complete documentation, documentation supporting services billed, evidence of billing services provided, and accurate data entry. Audits are completed while doing records reviews, as determined to be necessary, and as requested by internal and external sources. a. Inform the appropriate staff member of errors found and corrective actions needed. Monitor necessary corrections. b. Forward completed Financial Audit forms describing findings, proposed resolution, and rationale to the appropriate staff member, typically the Billing Department. c. The Records Reviewer maintains a financial audit database. Financial audit forms that require an adjustment or restore are filed in Billing after completion. 3. Additional review activities: a. Participate in EBP Fidelity reviews, as needed 4. Knowledge and understanding of all SMHC policies and procedures as well as state and federal laws, NH Administrative Rules and/or regulations, and payer standards related to compliance, documentation, confidentiality and performance. 5. Participate in monthly QI Committee meetings and carry out responsibilities related to the work of the committee. 6. Participate in other QI Department activities and responsibilities. a. Attend QI Department supervision meetings with VP-QC, QI Specialists and Program Assistants. Provide consultation to the Program staff when VP-QC is unavailable. b. Assist administrative and clinical staff as needed c. Collaborate with and assist Program staff as needed. d. Collaborate with and assist the Medical Records Coordinator and staff as needed. 7. Fulfill any other task as requested or necessary to improve and/or support SMHC’s quality improvement, compliance, financial, administrative, and clinical performance and processes. 8. Participate on various SMHC committees, work groups, and projects as appropriate to the position or areas of interest. 9. Other duties and responsibilities assigned which are consistent with employee's training and experience. Seacoast Mental Health Center, Inc. offers a generous compensation package including paid time off, health and dental plans, retirement account match, etc. We are an Equal Opportunity Employer, and we value the diversity of our community.

Keywords: Seacoast Mental Health Center, Pawtucket , Records Reviewer/ QI Specialist, Healthcare , Portsmouth, Rhode Island