Part-Time Quality Control Coordinator- CalAIM

Essential Duties and Responsibilities:

We are seeking a detail-oriented and analytical CalAIM Quality Control Coordinator to oversee and enhance our billing and

documentation processes related to all CalAIM services provided at Good Samaritan Shelter. The position will be responsible for

auditing processes, ensuring high-quality standards, and driving continuous improvement. This role involves being the primary

contact for monthly audits, addressing discrepancies, and supporting client eligibility and claims management. The Quality Control

Coordinator will also audit forms and touchpoints relevant to each claims program to ensure compliance and accuracy.

Process Auditing & Improvement:

● Conduct comprehensive audits of billing and service documentation processes to ensure accuracy and adherence to quality

standards.

● Act as the first point of contact for monthly auditing processes, making necessary rectifications in the ETO (Efforts to

Outcomes) system and correcting discrepancies.

● Serve as a primary reviewer for billing audits to ensure thorough and accurate reviews.

● Prepares financial or statistical summary reports as needed.

● Checks for accuracy of computations and completeness or supervises the preparation of daily, weekly and monthly reports

which are compiled into summary reports or claims for county, state or federal reimbursement

● Resolve discrepancies in daily reports by liaising with managers and staff.

Client Eligibility & Claims Support:

● Monitor client eligibility and provide timely reminders to claims staff regarding upcoming renewal dates.

● Coordinate with claims staff to ensure all necessary actions are taken to maintain and update client eligibility.

● Reconcile CenCal billing claims

● Proficient in navigation of the CenCal Health portal and ETO system

● Audit and monitor CalAIM claims by verifying adjustments and issues identified

Forms & Touchpoints Auditing:

● Perform monthly audits of forms and touchpoints associated with each CalAIM program to verify the appropriate number of

services have been provided and accurately documented.

● Ensure that all documentation meets the required standards and compliance guidelines.

Client Coordination:

● Investigate and direct member inquiries or complaints to appropriate staff members and follows up to ensure satisfactory

resolution

● Oversee and manage active, current clients to ensure ongoing compliance and quality service delivery.

Other:

● Accountable for completing and submitting work orders, procuring necessary supplies, and maintaining the facility in good

condition.

● Internally liaison with other departments, including finance, operations, data, and other program team

● Responsible for attending staff meetings, ensuring timely completion of training, and accurately completing timecards.

● Perform related duties as assigned by the supervisor.

● Maintain compliance with all company policies and procedures.

Education and/or Work Experience Requirements:

This section outlines the essential knowledge, skills and abilities are required to perform the daily tasks and job duties bulleted

above.

● High school diploma or equivalent.

● Bachelor’s degree in Business Administration, Healthcare Administration, or a related field preferred.

● Proven experience in a quality control or assurance role, particularly in billing and documentation processes.

● Strong analytical skills with a keen attention to detail.

● Technical proficiency in relevant software and tools.

● Excellent communication skills, both written and verbal.

● Effective problem-solving abilities and adaptability in a dynamic environment.

● Comprehensive knowledge of testing techniques and quality assurance methodologies.

● Strong documentation skills with the ability to maintain accurate and thorough records.

● Basic computer skills, including the ability to send and receive emails and summarize data in spreadsheets.

● Proficiency in Google Suite (Mail, Docs, Sheets, Calendar).

Required Qualifications:

Employment Eligibility Verification:

● Must provide documentation to establish identity and employment eligibility in compliance with legal requirements. This may

include a U.S. passport, Permanent Resident Card, or other acceptable forms of identification.

Negative Tuberculosis Test:

● Must provide documentation of a recent negative tuberculosis (TB) test result to ensure a safe and healthy work environment.

Background Screening:

● Successful completion of a comprehensive background screening, which may include criminal record checks, employment

history verification, and reference checks.

Pre-Employment Drug Screening:

● Must pass a pre-employment drug screening to ensure a drug-free workplace. A negative drug test result is required.

Driving Skills:

● Possess strong driving skills and have a valid drivers license.

● Driving is an essential function of the position, and a clean driving record may be required.

● Must possess a valid California drivers license or obtain one before the start of employment.

Insurance Coverage:

● Must be able to qualify for Good Samaritan Shelter insurance coverage, which may include meeting specific criteria related to

driving record, insurance claims history, and other factors.

Personal Insurance Coverage:

● Must have personal insurance coverage that meets the requirements set by the employer.

● This may include liability insurance, automobile insurance, or any other type of insurance deemed necessary for the position.

● The coverage must be valid and maintained throughout the employment period.

Benefits:

Full-Time Benefits:

● Health Insurance

● Dental, Vision, and Life Insurance

● 401k Matching

● Paid Time Off (PTO)

● Paid Holidays and Floater Day

● Employee Assistance Program

● Gym Membership Discount

● Tuition Reimbursement

● Working Advantage

Part-Time Benefits:

● 401k Matching

● Paid Time Off (PTO)

● Employee Assistance Program

● Gym Membership Discount

● Working Advantage

Please note that these benefits are subject to specific eligibility criteria and may be subject to change based on company policies

and guidelines.

Work Environment:

The work environment for homeless services with clients experiencing substance abuse or mental illness is characterized by a

commitment to creating a safe, supportive, and non-judgmental atmosphere. It is crucial to establish a secure environment that

prioritizes the well-being of both staff and clients. The work is often carried out through a multidisciplinary team approach, involving

professionals from various fields who collaborate to provide comprehensive support. Crisis management protocols and resources

should be readily available to address emergencies related to substance abuse or mental health. Ongoing training and professional

development opportunities equip staff with the necessary skills to effectively engage with clients and address their complex needs.

Additionally, the work environment should prioritize staff self-care and support, recognizing the potential challenges and providing

resources for their well-being. Confidentiality and privacy of client information are paramount, ensuring trust and maintaining ethical

standards. By fostering an inclusive and empathetic work environment, homeless services can effectively support clients on their

path to recovery and stability.

Physical Requirements:

The physical demands described here are representative of those that must be met by an employee to successfully perform the

essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the

essential functions.

● Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state

and local standards, including meeting qualitative and/or quantitative productivity standards.

● Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards

● Must be able to lift and carry up to 30 lbs.

● Proficiency in using hands and fingers to perform tasks such as typing, writing, handling paperwork, operating equipment, and

assisting residents with daily needs.

● Sufficient vision and hearing capabilities to observe and respond to the environment, communicate with residents and

colleagues, and maintain a safe working environment.

Mental Requirements:

The mental demands outlined above are illustrative of the requirements necessary for an employee to effectively fulfill the

fundamental duties of this position. Reasonable accommodations can be provided to enable individuals with disabilities to fulfill

these essential functions.

● Emotional resilience to cope with challenging situations and provide support to individuals facing difficult circumstances.

● The nature of working with individuals experiencing homelessness can be emotionally draining. Staff must be aware of the

signs of compassion fatigue and have strategies in place to manage their own self-care and prevent burnout.

● Establishing and maintaining appropriate boundaries is crucial when working with vulnerable populations. Staff should be able

to prioritize self-care, set limits on their emotional involvement, and practice self-reflection to prevent personal emotional

strain.

● Serving a diverse population with various cultural backgrounds and identities. Staff should have a strong commitment to

cultural sensitivity, respect for diversity, and the ability to communicate effectively with individuals from different backgrounds.

The Good Samaritan Shelter is a non-profit, community-based organization that relies on all members of staff to work together to

serve the community and clients. At times, you may be asked to take on additional tasks outside of your usual responsibilities as

needed.

Job Type: Part-time

Pay: $26.00 - $28.00 per hour

Expected hours: 8 – 30 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Application Question(s):

• How many years of auditing billing do you have?
• Do you have ETO experience?
• How many years of CalAIM services experience do you have?

Education:

• Bachelor's (Preferred)

Ability to Commute:

• Santa Maria, CA (Required)

Ability to Relocate:

• Santa Maria, CA: Relocate before starting work (Required)

Work Location: In person

Salary : $26 - $28