Quality Assurance Coordinator - Healthcare jobs in San Jose, CA

Abode values safety, wellness, and respect for each other and for those who we serve. Because of this commitment Abode is mandating that all employees be vaccinated effective September 30, 2021. Everyone deserves a home.

Abode’s mission is to end homelessness – doing whatever it takes to help those who need it most.

POSITION SUMMARY: The Quality Assurance Coordinator will provide support and assistance to the Program Manager and other administrative staff to ensure quality assurance and improvement of billing and data systems, charts, electronic health records, etc. related to this roles’ assigned CalAIM contracts.

Abode’s Benefits and Perks

• $68,000-$80,000 salary 
• 100% paid health, vision, and dental options
• 19 PTO days & 12 Holidays per year
• Voluntary benefits: FSA, EAP, Commuter Checks, Life Insurance, Legal, and more
• 3% retirement match/contribution 
• Professional Development Trainings and Opportunities, Leadership Academy Programs, and All Staff Events
• Dynamic, mission-driven culture and supportive leadership. We support you in supporting others

How You Make An Impact:

● Partner with an internal Abode team to develop a data/billing/evaluation plan, which lays out what systems, processes, and other infrastructures are needed to better manage our data systems and then use the data to inform the efficacy and evaluate our delivery of services.

● Serve as a subject matter expert in CalAIM ECM and CS regulations and the policies/procedures and support staff to understand key requirements and rules for successful claims submission, as well as the proper procedures for entering services.

● Ensure that program participants are approved and eligible for CalAIM services.

● Prepare weekly reports for managers to monitor service and billing activity.  

● Support staff with developing effective and efficient processes for referrals and program workflows.

● Lead monthly internal review of CalAIM service data and claims with Program Managers.

● Ensure that all claims are submitted on a timely basis each month and follow up on unpaid claims.

● Compile, track, and review denied claims; represent Abode in appeal of any denied claims.

● Monitor monthly claims against budget and supporting managers to understand if the program is meeting billing expectations.

● Implement regular internal monitoring of claims data looking for accuracy, completion, quality, and compliance with internal and external regulations; provide summaries and feedback to managers; identify and follow up on plans of correction and support the program with external monitoring requests.   

● Initiate and lead quality improvement initiatives related to CalAIM service delivery and claims.

● Ensure compliance with HIPAA requirements.

● Responsible for training new staff on office policies and protocols related to quality assurance and improvement, CalAIM standards as well as program policies and procedures.

● Establish and maintain positive, collaborative relationships with program staff.

● Other duties as assigned.

How You Meet Qualifications:

● Bachelor's degree in psychology, Human Services, Social Work, Sociology, or related field or equivalent Quality Assurance experience.

● Two years of experience working with Medi-Cal managed care plans or medical billing. 

● Work flexible hours, including occasional weekends and evenings when required.

● Reliable transportation and proof of a valid and current California Driver’s License and current insurance along with a clean DMV record required.  

Notice: This description is to be used as a guide only. It does not constitute a contract, commitment or promise of any kind. Abode Services reserves the right to change, add, delete, upgrade, or downgrade the position as dictated by business necessity at any time with or without notice.

Abode Services is an Equal Opportunity Employer/Drug Free Workplace