Quality Assurance & Billing Officer

ORGANIZATION

Partnerships for Trauma Recovery is a 501(c)(3) nonprofit organization dedicated to healing the

psychosocial impacts of trauma among international survivors of human rights abuses, persecution

related to identity and beliefs, and forced displacement resulting from war, torture, gender-based,

criminal, and other forms of interpersonal violence. PTR provides psychological, psychosocial, and

psychiatric care for asylum seekers and refugees from around the world; conducts community

outreach; supports training; and advocates for policies to prevent trauma and re-traumatization

among international survivors of violence. Founded in 2015, PTR has approximately 30 staff members

including 10 direct service staff members, is predominantly government grant-funded, and maintains

a yearly operating budget of a little over $2.5 million. We engage deeply in partnerships with

institutions and individuals around the San Francisco Bay Area and beyond.

POSITION OVERVIEW

Partnerships for Trauma Recovery (PTR) is seeking a Quality Assurance & Billing Officer to support

the organization's transition to Medi-Cal billing and Specialty Mental Health Services (SMHS)

compliance while strengthening documentation quality, data integrity, and quality assurance

systems. The Revenue Cycle, Quality Assurance & Billing Officer will be responsible for behavioral health

billing operations, clinical documentation review, utilization review, compliance monitoring, quality

improvement activities, and staff training. Working closely with clinical, operations, and leadership

teams, this position will help ensure services are accurately documented, appropriately billed,

compliant with county, state, and federal requirements, and supported by reliable data and

reporting systems. This position plays a critical role in helping PTR build the operational, compliance, and revenue cycleinfrastructure necessary to sustain high-quality, trauma-informed behavioral health services. The successful candidate will support the organization's ability to meet Medi-Cal, Alameda County

Behavioral Health, and other regulatory requirements while promoting quality care, financial

sustainability, and continuous improvement.

Position Reports to: Managing Director

ROLES & RESPONSIBILITIES

Revenue Cycle, Compliance & Billing 40%

● Manage PTR’s behavioral health on-going billing operations, including insurance eligibility

verification, claim review and submission, payment posting, denial management, and

reimbursement reconciliation.

● Monitor compliance with Medi-Cal, Specialty Mental Health Services (SMHS), HIPAA,

Alameda County Behavioral Health, grant, and organizational requirements.

● Manage reimbursement-related claiming processes.

● Develop and implement systems for at least weekly review of clinical and psychosocial

services’ documentation and records to ensure services are billable, properly supported,

accurately coded, and aligned with reimbursement requirements.

● Monitor authorization requirements and support timely authorization and reauthorization

processes.

● Monitor claim denials, authorization requirements and issues, and reimbursement trends

and recommend corrective actions to improve compliance and reimbursement outcomes.

● Maintain working knowledge of CPT, HCPCS, ICD-10, Medi-Cal, and other payer billing

requirements applicable to behavioral health services.

● Maintain awareness of regulatory and payer changes and communicate relevant updates to

staff and leadership.

● Coordinate PTR clinical provider credentialing, recredentialing, and enrollment processes

necessary to reimbursement.

● Coordinate internal and external compliance audit preparation and compile responses to

compliance audit findings, with the goal of protecting PTR against the financial implications

of denials.

● Ensure timely policy and procedure development and updating, as relates to compliance,

documentation, billing, and quality assurance.

Clinical Documentation Quality & Utilization Review 40%

● Conduct routine chart audits to ensure documentation is complete, accurate, timely, and

compliant with organizational, county, and Medi-Cal requirements.

● Review assessments, treatment plans, progress notes, discharge documentation, and other

clinical records to ensure documentation supports medical necessity and billing

requirements.

● Monitor documentation completion rates and identify trends, deficiencies, and areas for

improvement.

● Support authorization and utilization review processes, including documentation reviews,

continued stay reviews, and responses to payer requests when applicable.

● Collaborate with the Clinical Director and program managers to promote clinical

documentation quality, identify quality improvement opportunities, and support consistent

adherence to clinical, regulatory, and organizational standards.

● Track and monitor corrective actions related to documentation findings.

Data Integrity & Training 20%

● Develop and implement quality assurance and continuous quality improvement activities.

● Monitor data quality, completeness, and consistency across electronic health records,

reporting systems, and other organizational databases.

● Identify data discrepancies and collaborate with staff to improve data accuracy and reporting

reliability.

● Partner closely with the Data & Reporting Manager to develop quality assurance dashboards,

reports, and actionable recommendations for leadership.

● Provide individual and group training related to documentation standards, compliance

requirements, quality improvement practices, and billing readiness.

● Create documentation guides, tools, and resources to support staff success.

● Participate in organizational planning and implementation activities related to Medi-Cal

billing, quality improvement, and compliance infrastructure.

Required Qualifications

● Bachelor's degree in Public Health, Health Administration, Healthcare Management, Social

Work, Psychology, Nursing, or a related field.

● Two - three years of experience in behavioral health billing, utilization review, quality

assurance, compliance, review, healthcare operations, revenue cycle management, or a

related field.

● Experience working with Medi-Cal, Medicaid, behavioral health, or community mental

health programs.

● Experience conducting documentation reviews, chart audits, or compliance monitoring

activities.

● Knowledge of healthcare documentation standards, privacy regulations, and

reimbursement requirements.

● Strong analytical, organizational, and problem-solving skills.

● Experience working with Electronic Health Record (EHR) systems and data reporting tools.

● Excellent written, verbal, and training/facilitation skills.

Preferred Experience & Skills

● Clinical experience, and/or licensure as a mental health professional

● Experience with California Specialty Mental Health Services (SMHS).

● Experience supporting organizations transitioning to Medi-Cal billing or managed care

reimbursement.

● Experience with county behavioral health contracts.

● Certified Professional in Healthcare Quality (CPHQ), Certified Professional Compliance

Officer (CPCO), or similar credential, or actively working toward certification.

● Certified in medical billing, or actively working toward certification.

● Experience utilizing SmartCare or EPIC.

● Experience with Salesforce or similar data systems

● Experience with Excel, Access, Tableau or Power BI

● Experience working in nonprofit, community mental health, refugee, immigrant, or

trauma-focused service settings.

Core Competencies

● Global cultural & contextual awareness for working collaboratively with internationally diverse

clients & staff and a demonstrated commitment to global social justice and human rights.

● Strong administrative & organizational skills.

● Capacity for self-reflection, humility, respect for difference & ability to manage disagreement.

● Flexibility, patience & ability to adapt to developing program needs.

● Maturity, initiative, resourcefulness & ability to creatively problem-solve.

● Strong desire for personal & professional growth.

● Comfort with a culture that embraces constructive conflict

Salary & Benefits

● $70,000 - $85,000 annual salary based on skills and experience

● Health, dental, and vision Insurance

● Vacation, paid holidays, and sick leave

● Professional development allowance

● 401k retirement

● Flexible hybrid work schedule

The above statements are intended to describe the general nature and level of work being performed by the individual(s) assigned to this job. They are not intended to be an exhaustive list of duties, responsibilities, and skills required. Management reserves the right to modify, add, or remove duties, and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

If interested, please submit the following to jobs@traumapartners.org with the subject Application for Quality Assurance & Billing Officer: 1) a cover letter, and 2) your most recent curriculum vitae or resume. Applications will be reviewed on a continuous basis until the position is filled. To learn more about Partnerships for Trauma Recovery, please visit our website at www.traumapartners.org. PTR is committed to creating a diverse workplace that reflects the nature of our work as well as our international client population. BIPOC, LGBTQ and immigrant candidates are strongly encouraged to apply.

Partnerships for Trauma Recovery is an equal employment opportunities (EEO) employer and does not discriminate on the basis of ancestry, age, color, disability (physical and mental, includes HIV and AIDs), genetic information, gender, gender identity, gender expression, marital status, military or veteran status, national origin, race, religion (includes religious dress and grooming), sex (includes pregnancy, childbirth, breastfeeding, and/or related medical conditions), sexual orientation, or request for FMLA in accordance with applicable federal, state and local laws.