What are the responsibilities and job description for the Quality Assurance - CalAIM position at RH Community Builders?
Position Overview:The position is responsible for ensuring the accuracy, integrity, and compliance of billing processes under all RH Community Builders CalAIM programs. This role involves reviewing billing errors, identifying and analyzing patterns, resolving issues to prevent recurrence, and recommending system and process improvements to enhance operational efficiency and compliance.
Key Responsibilities:
- Error Review and Resolution:
- Conduct detailed reviews of billing errors and discrepancies.
- Work with billing staff and other departments to identify root causes and resolve errors promptly.
- Ensure resolved issues are documented and shared for future reference.
- Pattern Analysis:
- Analyze recurring billing errors to identify trends and systemic issues.
- Investigate common patterns that contribute to errors and inefficiencies.
- Maintain detailed records and reports on identified trends.
- System Improvements:
- Collaborate with the compliance and IT teams to recommend system modifications or enhancements.
- Develop and propose workflow improvements to minimize error rates.
- Stay updated on CalAIM billing requirements and suggest changes to align with regulations.
- Training and Support:
- Provide feedback and training to billing staff on common error patterns and prevention techniques.
- Create resources, guides, and checklists to enhance billing accuracy.
- Compliance and Reporting:
- Ensure all billing processes adhere to CalAIM regulations and organizational policies.
- Prepare reports for leadership, highlighting findings, trends, and improvement recommendations.
- Support compliance audits related to billing accuracy and integrity.
Qualifications:
- Proven experience in medical billing, quality assurance, or compliance, preferably within the Medi-Cal or CalAIM framework.
- Strong analytical skills with the ability to identify patterns and root causes.
- Proficiency in billing software, data analysis tools, and reporting systems.
- Excellent communication skills, both written and verbal.
- Detail-oriented with a proactive approach to problem-solving.
- Knowledge of Medi-Cal regulations and CalAIM initiatives is highly desirable.
Salary : $70,000 - $80,000
