Quality Data and Compliance Support Administrator

Description

Lutheran Social Services of Southern California began in December 1944 when a group of Lutheran congregations in San Diego came together to discuss how to better assist families in need. They began discussing how to form a Welfare Commission. Their vision expanded when they came together with another group of Lutheran congregations in Los Angeles having the very same conversation. Lutheran Social Services of Southern California was officially incorporated in 1946 as a 501(c)(3) non-profit social service agency. The mission has stayed true to its earliest beginnings, to be a servant to those in need. Today LSSSC serves thousands of individuals and families throughout Southern California with over 40 different programs/services at 16 different locations. We are part of the Lutheran Services in America (LSA) network and strive to serve those in need with dignity and respect.

Lutheran Social Services of Southern California’s Mission: Ignited by faith, we live out God’s love by embracing, equipping, and empowering vulnerable individuals, families, and communities toward self-sufficiency. .

Job Summary: Under the direction and supervision of the CalAIM Programs’ QA/Compliance Manager or designated supervisor, the Quality Data and Compliance Support Administrator provides administrative support and serves as an LSSSC intra and inter-department liaison in the tracking, collecting, processing, and analyzing of large datasets. This position ensures the collection of accurate medical/healthcare data from various sources in a timely manner, the resolution of issues, and compliance with the billing claims policies and guidelines of DHCS and Managed Care Plans (MCPs). The Quality Data and Compliance Support Administrator provides timely internal communications with the organizational and divisional leaders in support of business decision-making for the CalAIM Programs. This position supports internal audit and continuous improvement processes by assuring compliant billing practices, accurate coding, adherence to regulations, and maintenance of accurate billing data reports. This position collaborates with LSSSC’s Finance and Compliance Departments, CalAIM Programs’ Leadership Team, and external stakeholders including MCPs, health and social network partners to coordinate and facilitate efficient CalAIM Programs’ data analytics and billing compliance. 

Essential Duties and Responsibilities include the following. Other duties may be assigned. 

· Serves as primary technical resource to implement exploratory data analysis to identify trends and patterns.

· Performs process improvement and troubleshooting.

· Develops and applies statistical models to analyze large datasets.

· Creates clear and compelling visualizations to communicate findings to stakeholders.

· Uses tools like Excel, Power BI, and/or other visualization software programs.

· Generates regular reports on key performance indicators (KPIs) and metrics.

· Prepares reports on findings and recommendations for policy, procedure, and internal control improvements.

· Maintains organized and up to date records and ensures that proper documentation is retained for auditing and reporting purposes.

· Intersects and coordinates with CalAIM centralized and medical billing and claims processing teams in all billing data tracking, collecting, reconciling, and submitting and/or reporting.

· Communicates with the Finance Department to report monthly CalAIM program billing data.

· Collaborates with the Finance Department to analyze, problem-solve, and reconcile invoices. 

· Performs data processing and data imports into and within the medical Billing system(s).

· Delivers timely and accurate response to ad hoc data-related requests.

· Implements data-driven continuous quality improvement process for CalAIM program services.

· Extracts and organizes data and applies quality-control techniques to ensure the accuracy and completeness of all data.

· Collaborates with CalAIM billing and claims teams and other IT staff at LSSSC to develop data pipelines and ensure the availability of quality data for billing processing and reporting functions.

· Ensures the accurate and timely submission of billing reports. 

· Disseminates insights, practical knowledge, and protocols to support billing process for Medi-Cal billing plans such as Anthem Blue Cross, Health Net, L.A. Care Health Plan, Molina Healthcare, Kaiser Permanente, Blue Shield of California Promise Health Plan, and other MCPs.

· Demonstrates proficiency in medical billing software and electronic health records (EHR), Availity, Office Ally, Conduent, and/or billing interfaces.

· Assists in billing processes, including verification, pre-authorization, and claims appeal procedures.

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