Billing Compliance & Documentation Auditor

South Coast Community Services; Placentia (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

South Coast Community Services seeks a detail‑oriented Billing Compliance Specialist to ensure all billed services are supported by up‑to‑date documentation per Medi‑Cal, DHCS, and County standards.

You will audit records, verify CANS/ASAM/PSC-35 items, detect discrepancies, and coordinate corrections with clinical and billing staff. The role includes training, data submission for Exhibit D ISL, and assisting in monthly program reports.

Qualifications

• Bachelor's degree in health information management, social work, psychology, or related field.
• At least 3 years of behavioral health documentation review, utilization review, or QA experience, preferably Medi-Cal SMHS.
• Familiarity with SMHS documentation requirements, CalAIM, and county standards.
• Comfortable training clinicians and paraprofessional staff.

Responsibilities

• Ensure all billed services are documented per Medi-Cal, DHCS, and County standards.
• Audit progress notes, assessments, and care plans for compliance monthly.
• Verify required items (CANS, PSC-35, ASAM, HFW criteria) and credentials.
• Match services to claims, detect errors, and correct or void as needed.
• Identify and resolve duplicate MRNs and ensure data posts to correct records.
• Provide feedback and corrections to staff; track until resolved.
• Train new hires on documentation and billing standards with HR coordination.
• Submit Exhibit D ISL data using County codes; fix data errors within deadlines.
• Assist in monthly programmatic reporting and QA/QI KPI tracking.
• Support county/state compliance audits and corrective action plans.
• Report suspected billing irregularities to Compliance Officer.

Skills

Documentation review

Utilization review

QA experience

Training and coaching

Education

Bachelor's degree in health information management or related field

Tools

myEvolv

Job description

South Coast Community Services seeks a detail‑oriented Billing Compliance Specialist to ensure all billed services are supported by up‑to‑date documentation per Medi‑Cal, DHCS, and County standards.

You will audit records, verify CANS/ASAM/PSC-35 items, detect discrepancies, and coordinate corrections with clinical and billing staff. The role includes training, data submission for Exhibit D ISL, and assisting in monthly program reports.