POSITION SUMMARY
Mary's Path is seeking a Quality Assurance Manager for our behavioral health program serving teen mothers in foster care and their babies. The QA Manager is responsible for overseeing all aspects of quality assurance across the programs, including maintaining compliance with Medi-Cal regulations, DHCS' Short Term Residential Therapeutic (STRTP) standards, CalAIM documentation requirements, contract oversight, and overall mental health audit compliance. This position is also responsible for the Medi-Cal billing, claiming, and reconciliation of all services provided by the program staff. The ideal candidate will have experience working in the non-profit/behavioral health sector, is familiar with CalAIM standards, has a keen eye for detail and follow through and is proactive.
To be considered for the Manager role, the applicant MUST have experience billing Medi-Cal specialty mental health services through a county billing system (preferably Los Angeles County system IBHIS and/or Orange County's system IRIS, but other county mental health billing systems will be considered based on the candidate's experience). The Quality Assurance Manager reports to the Head of Service.
RESPONSIBILITIES
- Responsible for overseeing all billing system entries for contracted counties in coordination with program QA staff.
- Complete billing reconciliation activities monthly to ensure alignment between county billing systems and internal EHR data.
- Ensure prompt resolution of denied or incomplete claims.
- Monitors Medi-Cal documentation of program staff for completeness and compliance with EPSDT and DHCS STRTP requirements
- Distributes necessary information to various departments within the agency as well as county partners.
- Ensure authorizations are obtained from county partners, as necessary.
- Collaborates with agency leadership finance staff regarding billing and invoicing amounts, discrepancies, denials and payments, including provision of regular reports on these topics.
- Liaison with various county personnel to ensure ongoing collaboration, field concerns, and rectify any issues.
- Coordinate with program leadership and staff to ensure that both the needs of the program and the needs of QA are being met in a timely manner.
- Develops manuals, policies and procedures as appropriate for the role.
- Manage Exym EHR system as it relates to mental health documentation and systems.
- Oversees Internal Audits of each program to assess for Medi-Cal, contract and agency compliance
- Track all issues related to documentation and billing, including internal and external communication ensuring resolution.
- Participates in the development of trainings focusing on documentation and compliance
- Oversees QA development for new county contracts and any new programs created within the agency
- Ensures programmatic understanding of behavioral health contracts and serve as the primary point person for all contract compliance issues.
- Supervise QA staff and support with their tasks as necessary.
- Additional duties as requested by the Head of Service
QUALIFICATIONS
- Preferred: Masters Level Degree, preferably in Social Services
- Minimum: Bachelor’s Degree, preferably in Social Services
- Experience managing Medi-Cal billing processes within LA County’s Department of Mental Health and Orange County Health Care Agency.
- One year of supervisory experience.
- Highly skilled in Excel with the ability to report data (e.g. fiscal trends, client outcomes, or other relevant programmatic data) into graphs or pivot tables.
- Fingerprint clearances.
- Access to a vehicle, valid California Driver’s License and insurance.
- Excellent organizational, analytical, computer and communication skills.
- Ability to prioritize projects.
- Ability to work as a team member.
COMPENSATION
Salary Range $74,095 to $87,000. Salary Exempt
Job Type: Full-time
Pay: $74,095.00 - $87,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Paid time off
- Retirement plan
- Vision insurance
Schedule:
Ability to commute/relocate:
- Santa Ana, CA 92705: Reliably commute or planning to relocate before starting work (Required)
Application Question(s):
- What EHR systems are you familiar with?
- How many years of experience do you have billing Medi-Cal services to County Behavioral Health Departments? For example, processing claims in LA County's IBHIS system, or Orange County's IRIS system. Other county experience is applicable, but it must be directly managing Medi-Cal claims through a county behavioral health system. (Note that this question is not referring to billing services to private insurance or managed care companies.)
Education:
Experience:
- Management: 1 year (Required)
Work Location: In person