County Claims & Compliance Specialist (Hybrid Option)

California Department of Health Care Services; Sacramento (CA); Ibrido; USD 74.000 - 93.000; Tempo pieno

Vantaggi offerti da questo lavoro

Continuous training

DEI program activities

Employee Assistance Program (EAP)

Medical, dental, and vision insurance

Paid holidays and vacation/leave

Defined retirement program

Savings Plus Program (401k, 457)

Reimbursement accounts

Descrizione del lavoro

California Department of Health Care Services is seeking a Health Program Specialist I in Sacramento County to serve as a technical program consultant and expert advisor for Medi-Cal behavioral health fiscal policies and claiming systems.

The role requires independent initiative, strong analytical abilities, and the ability to handle confidential information while advising on complex policy matters and ensuring compliance with regulations.

Competenze

• Strong analytical skills with the ability to problem-solve and use critical and creative thinking.
• Ability to communicate effectively orally and in writing with internal and external stakeholders.
• Knowledge of research, survey, and analytical methods and techniques.
• Ability to prepare and present technical reports and make recommendations.
• Ability to manage and prioritize multiple projects.
• Ability to work independently and in a team environment.
• Experience using Microsoft Excel or similar data management software.
• Experience analyzing data and making recommendations for process improvements to a system or project.

Mansioni

• Provide policy and consultative advice on complex and sensitive policy matters within the Branch.
• Function as a Branch expert advisor and specialist for Medi-Cal behavioral health fiscal policies and claiming implementations.
• Perform complex analytical and research activities related to behavioral health care services for Medi-Cal beneficiaries.

Conoscenze

Analytical skills

Communication

Research methods

Technical reporting

Project management

Independent work

Excel experience

Data-driven improvements

Descrizione del lavoro

Work Location

Sacramento County

Job Description

Why Join DHCS?
The Department of Health Care Services (DHCS) is the backbone of California’s health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities. This is an exciting opportunity to join our diverse team in the following role.

In this role, under the direction of the MedCCC Supervisor I in the SDMC Section, the Health Program Specialist I (HPSI) will serve as a skilled technical program consultant, providing policy and consultative advice on complex and sensitive policy matters within the Branch. The HPSI will function as a Branch expert advisor and specialist for Medi-Cal behavioral health fiscal policies and the respective implementation of claiming policies in the Short Doyle Medi-Cal adjudication and payment systems. The HPSI is a member of the County Claims Customer Services (MedCCC) Unit. The MedCCC Unit provides technical assistance and customer service to 58 county mental health plans and behavioral health departments related to fiscal and claiming policies for Medi-Cal’s behavioral health programs. The HPSI independently performs a variety of complex analytical and research activities related to behavioral health care services delivered to Medi-Cal beneficiaries in California. The incumbent is required to demonstrate initiative, good judgment, and the ability to handle confidential/sensitive information when performing assigned tasks. The incumbent is subject matter expert in ensuring adherence with all federal and state Medicaid claim payment laws, regulations, and directives. The incumbent is also responsible for maintaining ongoing technical support for complete, timely, and accurate claim inquiries. The incumbent performs complex administrative responsibilities including researching, and analyzing behavioral health claim payment legislation, policies, and procedures and making recommendations on optimal solutions, trouble‑shooting behavioral health claim problems; editing documentation for quality control; interpreting and applying federal regulations and directives; creating, implementing, or revising state regulations, policies and procedures.

Working Conditions

Please see the Telework and Salary Information section below for telework, reporting location, and temporary statewide salary reduction details.

Minimum Requirements

HEALTH PROGRAM SPECIALIST I

Additional Documents

• Job Application Package Checklist
• Duty Statement

Position Details

Job Code #: JC-528327

Position #(s): 805-785-8338-XXX

Working Title: County Claims & Compliance Specialist (Hybrid Option)

Classification: HEALTH PROGRAM SPECIALIST I

$6,623.00 - $8,290.00

New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable.

# of Positions: Multiple

Work Location: Sacramento County

Telework: Hybrid

Job Type: Permanent, Full Time

Benefits

• Continuous and ongoing training
• Diversity, Equity, and Inclusion program activities
• Employee Assistance Program (EAP)

• Medical, including health, dental, and vision insurance.
• Paid Holidays and vacation/leave
• Defined retirement program
• Savings Plus Program (401(k), 457)
• Medical/Dependent Care Reimbursement Accounts

Desirable Qualifications

• Strong analytical skills with the ability to problem-solve and use critical and creative thinking skills.
• Ability to communicate effectively orally and in writing with internal and external stakeholders.
• Knowledge of research, survey, and analytical methods and techniques
• Ability to prepare and present technical reports and make recommendations
• Ability to manage and prioritize multiple projects
• Ability to work independently and in a team environment
• Experience using Microsoft Excel or similar data management software.
• Experience analyzing data and making recommendations for process improvements to a system or project.

Contact Information

The Hiring Unit Contact is available to answer questions regarding the position or application process.

Hiring Unit Contact:
Alyssa Antuna
[phone]
[e-mail]

Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.

EEO Contact:
EEO Officer
[phone]
[e-mail]

California Relay Service: 1-800-735-2929 (TTY), 1-800-735-2922 (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device.

Telework and Salary Information

This position is currently eligible for telework. The amount of telework is at the discretion of the Department and is subject to change consistent with DHCS’ Telework Program and Government Code sections 14200 – 14203. Telework is available to California residents, and proof of residency may be required.

Business travel may be required, and reimbursement considers an employee’s designated office and residence subject to regulations and bargaining unit contract provisions. All commute expenses to the reporting location will be the responsibility of the selected candidate.

The DHCS office location for this position is 1501 Capitol Avenue, Sacramento CA, 95814.

Salary: Effective July 1, 2025, the California Department of Human Resources (CalHR) implemented the temporary Personal Leave Program 2025 (PLP 2025). PLP 2025 directs that each employee receive a temporary reduction in pay in exchange for PLP 2025 leave credits. The temporary salary reduction percentage and the number of PLP 2025 leave credits are based on the position’s associated bargaining unit. The salary range(s) included in this job advertisement do not include the temporary salary reduction. Please reach out to the hiring unit contact listed on this job advertisement for details.

Equal Opportunity Employer

The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.

It is an objective of the State of California to achieve a drug-free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.