Quality Assurance & Billing Specialist

CLASSIFCATION SUMMARY:

Volunteers of America Southwest’s (VOASW) Enhanced Care Management (ECM) program provides a whole person approach to care for Medi-Cal beneficiaries. VOASW believes in individualizing services based on need and what works best for the member, thus through care management and care coordination we asses need and connect individuals to services and resources most appropriate for them. Through the delivery of these services, we hope every member can improve their quality of life, establish a support system and develop healthy living choices. The Supervising Care Manager ensures effective and efficient care management and care coordination throughout the Enhanced Care Management program by carrying a caseload and providing direct supervision to Care Managers. The role serves as a supervisory position that is responsible for direct services and the direct oversight of staff. The Supervising Care Manager assists staff in making informed decisions about member care and services while ensuring staff have knowledge about resources. 

ESSENTIAL DUTIES AND RESPONSIBILITES:

Quality Assurance

• Audit ECM service documentation for accuracy, completeness, and compliance.
• Identify gaps in care documentation and initiate corrective actions.
• Monitor adherence to DHCS and health plan guidelines.

Billing & Revenue Integrity

• Validate billing submissions for ECM services to ensure accuracy and timeliness.
• Reconcile service encounters with claims data to prevent denials and revenue loss.
• Collaborate with finance and care teams to resolve billing discrepancies.

Reporting & Compliance

• Prepare QA and billing performance reports for leadership.
• Support internal and external audits related to ECM services and billing.
• Maintain up-to-date knowledge of CalAIM and ECM billing requirements.

Training & Support

• Provide guidance to staff on documentation and billing best practices.
• Assist in developing workflows that improve compliance and efficiency.

Equal Opportunity Employer

This employer participates in E-Verify. Applications are accepted online only.

REQUIRED CREDENTIALS, ABILITIES AND EXPERIENCE

• Bachelor’s degree in health administration, finance, data, accounting or related field (or equivalent experience).
• Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) (preferred).
• Knowledge of Medi-Cal regulations, CMS guidelines, and HIPAA compliance.
• Familiarity with ICD-10, CPT, and HCPCS coding standards.
• 2+ years in healthcare quality assurance, billing, or compliance.
• Experience with managed care billing and regulatory audits preferred.
• Familiarity with ECM program requirements and Medi-Cal managed care preferred.
• Strong attention to detail and analytical skills.
• Proficiency in EHR systems and Microsoft Office Suite.
• Excellent communication and problem-solving abilities.
• Language: Bilingual skills (e.g., Spanish) are highly valued.
• Ability to work independently.