Quality Assurance (QA) & Billing Specialist

Position Title: Quality Assurance (QA) & Billing Specialist

Department: Administrative

Report to: Sr. Director of Finance & Operations

Salary Range: $33 - $38 per hour

Location: Residential Facility

Type: Full Time, Non-Exempt

Position Summary

The Quality Assurance (QA) & Billing Specialist works onsite at the Residential Facility and is responsible for supporting the integrity, accuracy, and compliance of billing and clinical documentation for residential substance use disorder treatment services under the Drug Medi-Cal Organized Delivery System (DMC-ODS). This position ensures that services billed to Medi-Cal and other funding sources comply with requirements established by the California Department of Health Care Services (DHCS), the San Diego County Substance Use Disorder Provider Operations Handbook (SUDPOH), and applicable federal and state regulations.

The QA & Billing Specialist works collaboratively with clinical, administrative, and finance staff to review documentation, verify service eligibility, support billing accuracy, and identify areas requiring corrective action or training. This position plays a key role in maintaining compliance with documentation standards, preventing disallowed claims, and supporting internal quality improvement efforts.

Essential Functions

Billing and Claims Management

• Prepare and submit claims for residential treatment services in accordance with DMC-ODS billing requirements and San Diego County SUDPOH guidelines
• Verify completeness and accuracy of billing data
• Reconcile billing reports with internal documentation to ensure services billed match documentation provided
• Monitor and resolve claim denials, rejections, and billing discrepancies
• Maintain detailed billing records and support reconciliation with internal financial reporting
• Assist with monthly billing reconciliations and support fiscal close activities
  
  

Documentation and Compliance Review

• Conduct routine quality assurance reviews of clinical documentation to ensure compliance with DHCS DMC-ODS documentation requirements, San Diego County SUDPOH standards, and Medi-Cal billing regulations
• Verify that required documentation exists to support billed services
• Identify documentation deficiencies and coordinate corrective actions with treatment staff
• Track and report recurring documentation issues to support training and quality improvement
  
  

Quality Assurance and Audit Support

• Assist with internal chart audits to ensure compliance with County and DHCS requirements
• Prepare documentation and reports to support County monitoring reviews, DHCS audits, and internal compliance reviews
• Maintain QA tracking logs and assist with monitoring corrective action plans when deficiencies are identified
• Support implementation of quality improvement initiatives related to documentation, billing, and service delivery
  
  

Data Monitoring and Reporting

• Generate and review reports from the EHR and billing systems to monitor billing trends, documentation completeness, and service utilization patterns
• Assist leadership with data collection and reporting required for County or DHCS oversight
  
  

Collaboration and Training

• Provide guidance to clinical and treatment staff regarding documentation and billing requirements
• Assist with staff training on documentation standards, billing compliance, and QA processes
• Collaborate with program leadership to improve documentation workflows and ensure compliance with regulatory standards
  
  

Operational Support

• Provide administrative support to managers, directors, and executive leadership on special projects, task coordination between departments and follow up tasks as assigned
• Maintain organized records, files and administrative systems related to operational, bill, and leadership support functions
• Performs other executive support and administrative duties as needed to support effective organizational operations
  
  

Minimum Qualifications

• Associate or Bachelor’s degree in healthcare administration, public health, business administration, accounting, or a related field preferred
• Minimum 2 years of experience in Medi-Cal billing, behavioral health billing, or healthcare compliance, preferably within substance use disorder treatment programs
• Experience working with DMC-ODS or behavioral health billing systems strongly preferred
• Knowledge of clinical documentation requirements for Medi-Cal reimbursable services
• Strong attention to detail and ability to interpret regulatory requirements
• Advanced Excel skills (pivot tables, vlookup, etc.)
• Current CPR/First Aid Certification (or within 90 days of hire)
• Strong interpersonal and communication skills, with the ability to instruct and guide trainees of varying skill levels
• Successful completion of a criminal background check
  
  

Environmental Factors And Conditions/ Physical Requirements

• Work primarily in a climate controlled environment with minimal safety/health hazard potential
• Office environment, exposure to computer screens for lengthy periods of time
• May require occasional evening and weekend work
• This position may occasionally lift and/or move more than 25 pounds
  
  

Benefits Package

Stepping Stone is proud to offer a generous benefits package for full-time employees, representing the potential additional $10,000 on average per full-time employee above base pay, including but not limited to:

• Health Premiums company paid, including Acupuncture and Chiropractic
• Dental & Vision company paid
• Flexible Spending Accounts (Health Care & Dependent Care)
• Generous paid time off – sick & vacation
• Employee Assistance Program
• 403(b) Retirement Employer Match up to 5%
• 15 Paid Holidays, including floating holidays
• Life/AD&D Insurance company paid
• Long Term Disability Insurance company paid