Medi-Cal Billing Compliance & Documentation QA Auditor

South Coast Community Services; Placentia (CA); On-site; USD 80,000 - 100,000; Full time

Job summary

South Coast Community Services seeks a detail-oriented professional to ensure Medi-Cal/SMHS documentation aligns with county standards. You will manage ISL data reporting and ensure accurate linkage between services, billing, and client records.

The role requires 3+ years of QA in behavioral health, strong training skills, and proficiency with documentation systems like myEvolv. On-site work in California with a focus on compliance and accuracy.

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 in Medi-Cal SMHS.
• Detailed knowledge of SMHS documentation requirements, CalAIM documentation redesign, and medical necessity criteria.
• Comfortable training and coaching clinicians and paraprofessional staff.

Responsibilities

• Update and verify intake forms and informing materials with current County and DHCS versions.
• Audit samples of progress notes, assessments, and care plans for SMHS standards, CalAIM requirements, and County manuals.
• Confirm required items (CANS, PSC-35, ASAM screening, HFW criteria) are documented on time.
• Match documented services to claims, check codes, units, and time; flag incorrect claims.
• Identify duplicate MRNs and route duplication requests to HCA via IRIS; track until resolved.
• Provide feedback and corrections to HFW and ICM staff; track until resolved.

Skills

Audit & QA

Training staff

Documentation review

Education

Bachelor’s degree in health information management or related field

RHIT/CPC/CPMA certification or CA license

Tools

IRIS system

myEvolv

Job description

South Coast Community Services seeks a detail-oriented professional to ensure Medi-Cal/SMHS documentation aligns with county standards. You will manage ISL data reporting and ensure accurate linkage between services, billing, and client records.

The role requires 3+ years of QA in behavioral health, strong training skills, and proficiency with documentation systems like myEvolv. On-site work in California with a focus on compliance and accuracy.