Quality Assurance & Compliance Specialist (DMC Billing)

NATIONAL COUNCIL ON ALCOHOLISM; California (MO); Hybrid; USD 85,000 - 110,000; Full time

Job summary

NCADD-SFV in Los Angeles is seeking a Quality Assurance Specialist to support the integrity, accuracy, and timely billing of Drug Medi-Cal (DMC) services. This role ensures documentation is medically necessary, properly recorded, and compliant with SAPC, DHCS, Medi-Cal and CalAIM requirements.

The specialist conducts pre-billing reviews, audits, and ongoing chart reviews, collaborating with clinical and administrative staff to strengthen compliance and reduce billing errors.

Qualifications

• Hands-on experience with Los Angeles County DMC billing and documentation workflows.
• Ability to verify medical necessity and appropriate staff credentials.
• Experience conducting pre-billing reviews and addressing discrepancies.

Responsibilities

• Review clinical documentation to ensure alignment with billed services.
• Perform internal audits and monitor compliance with SAPC/DHCS/Medi-Cal standards.
• Coordinate corrections with staff and track resolution of issues.
• Support preparation for external audits and response to findings.
• Collaborate with clinical leadership to improve documentation and billing processes.

Skills

DMC Billing

Documentation Review

Quality Assurance

Regulatory Compliance

Tools

Sage-PCNX

Electronic Health Record Systems

Job description

NCADD-SFV in Los Angeles is seeking a Quality Assurance Specialist to support the integrity, accuracy, and timely billing of Drug Medi-Cal (DMC) services. This role ensures documentation is medically necessary, properly recorded, and compliant with SAPC, DHCS, Medi-Cal and CalAIM requirements.

The specialist conducts pre-billing reviews, audits, and ongoing chart reviews, collaborating with clinical and administrative staff to strengthen compliance and reduce billing errors.