POSTION SUMMARY:
The CalAIM Billing & Data Specialist is responsible for overseeing all aspects of CalAIM data integrity, electronic health records (EHR), Medi-Cal billing operations, revenue cycle management, reporting, quality assurance, and regulatory compliance for Enhanced Care Management (ECM), Community Supports (CS), Recuperative Care, and other DHCS-funded services.
Why St. Mary’s Community Services?
• Mission-Driven Leadership – Be at the heart of an organization dedicated to serving the most vulnerable.
• Strategic Influence – Shape policies and initiatives that uplift lives and drive systemic change.
• Collaborative Environment – Work alongside a passionate team, community partners, and dedicated stakeholders.
• Sustainable Impact – Lead an organization committed to long-term solutions for housing, healthcare, and social support.
Essential Duites & Responsibilities
CalAIM Billing & Revenue Cycle Management
- Review claims for accuracy and compliance prior to submission.
- Manage authorization tracking and service eligibility verification.
- Monitor denied claims.
- Serve as a liaison with Managed Care Plans regarding billing issues.
EHR Administration & Systems Management
- Support billing operations and assist with claims tracking and follow-up.
- Assist staff with EHR data entry, troubleshooting, and reporting needs.
- Provide onboarding and ongoing EHR training
Compliance & Quality Assurance
- Conduct routine chart audits and documentation reviews.
- Assist leadership with documentation reviews and compliance tracking
Data Management & Reporting
- Develop dashboards and performance reports.
- Monitor program outcomes and KPIs.
- Ensure accurate reporting to DHCS, MCPs, and leadership.
Key Performance Indicators (KPIs):
- 95% Documentation compliance score
- 98% Data accuracy rate
Working Environment
This position operates primarily in a professional office environment. The employee will routinely use standard office equipment, including computers, telephones, printers, copiers, and other business technology. The role requires prolonged periods of sitting, frequent computer use, and regular communication with staff, clients, community partners, and stakeholders. The work environment is collaborative, fast-paced, and mission driven, requiring the ability to manage multiple priorities while maintaining professionalism and confidentiality.
What You Bring:
- Bachelor’s degree in Healthcare Administration, Public Health, Business Administration, Health Information Management, or a related field.
- Two to three years of experience in healthcare administration, medical billing, behavioral health operations, or CalAIM support services preferred.
- Experience with Medi-Cal, CalAIM, Enhanced Care Management, Community Supports, and Managed Care Plans preferred.
- Excellent relationship building skills with internal teams, community partners, and external stakeholders.
- Highly organized and adaptable, with strong communication and leadership skills.
- Bilingual English-Spanish speaking preferred.
Benefits:
• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Vision Insurance
• Paid time off
SMCS is an Equal Opportunity Employer. We are committed to creating a diverse and inclusive workplace that values and respects all individuals. Employment decisions are based on merit, qualifications, and business needs, without regard to race, color, religion, creed, national origin, ancestry, age, disability, medical condition, genetic information, marital status, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), gender, gender identity, gender expression, sexual orientation, military or veteran status, or any other status protected by applicable federal, state, or local laws.
