Hopecoop
Quality Assurance Specialist - Hope Cooperative (TLCS, Inc.)
Hopecoop, Sacramento, California, United States, 95828
Quality Assurance Specialist - Hope Cooperative (TLCS, Inc.)
Full Time Professional Sacramento, CA, US
4 days ago Requisition ID: 2984
Are you a motivated individual with a passion for supporting others and making a difference in the community? Hope Cooperative is a highly respected, award-winning nonprofit provider of a full array of mental health and supportive housing services in Sacramento County, and we need you to bring your compassion and support to the most vulnerable in our community. We are looking for dynamic, committed individuals to join our team!
Title:
Quality Assurance Specialist
Program(s) and Location:
Quality Assurance (Sacramento, CA)
Schedule:
Full-time non-exempt, 40 hours/week, Monday- Friday 8:00am-4:30pm
Pay rate:
$24.14/hour
Benefits:
HOPE Cooperative (aka TLCS, Inc.) offers a competitive benefits package consisting of, but not limited to, the following, and may be subject to change:
21 PTO days per year (4 weeks & 1 day)
26 PTO days after the 5 th year (5 weeks & 1 day)
11 paid holidays
1 Personal Day
Leadership Development!
Reimbursements!
Eligible for Government Loan Forgiveness Programs
Employer-paid health insurance for employees and children (Kaiser, Sutter or Western Health Advantage)
HSA Contributions
Flexible Spending Account
PTO Cash Out
Voluntary Dental, Vision, Life Insurance, Accident Insurance, Disability Insurance and more
Employee Assistance Program
Regular wage step scale increases
Flexible start/end times for some positions
iPhone with unlimited data for personal/professional use and laptop for some positions
Clinical Supervision towards licensure (for certain positions and upon approval)
CEU days for certain positions
Up to $500 CEU allowance for certain positions
Annual BBQ and staff appreciation awards
Annual Gift Card Program
* All benefit offerings are subject to change and are governed by the eligibility guidelines in the Employee Handbook. This list represents a general summary of available benefits and nothing stated here should be interpreted as being included in a written offer for employment.
Position Description:
The Quality Assurance Specialist, reporting to the Quality Assurance Manager, ensures accuracy, compliance, and efficiency across the organization’s Medi-Cal billing programs. This role supports the revenue cycle by reviewing claims, identifying errors, monitoring billing trends, and ensuring adherence to payer rules, coding guidelines, and internal standards. The Specialist also monitors the quality of services provided through routine chart audits, ensuring compliance with organizational standards and county requirements. The ideal candidate is detail-oriented, highly organized, and experienced in behavioral health billing practices.
Essential Duties and Responsibilities:
(includes the following; other duties may be assigned)
Review and update clients’ Medi-Cal eligibility on a monthly basis, and prepare and distribute an eligibility spreadsheet to the assigned program to ensure accurate billing and timely reimbursement.
Process medical record requests
from a variety of agencies—including Social Security, attorneys, courts, physicians, and individuals—while ensuring strict adherence to all
HIPAA-compliant guidelines and confidentiality regulations .
Provide feedback, training, and quality improvement recommendations to billing staff, clinicians, and administrative teams.
Collaborate with billing leadership to refine workflows, enhance quality standards, and support ongoing process improvement initiatives.
Identify trends, errors, or process gaps that lead to denials, delays, or billing inconsistencies.
Act as a designated Mandated Reporter, fulfilling the responsibility to report suspected abuse or neglect of children, dependent adults, disabled individuals, and seniors. This includes adhering to the "Duty to Warn" protocols by notifying authorities and potential victims of threats of physical harm.
Ensure the protection and confidentiality of all Protected Health Information (PHI) by following all policies and procedures in the HIPAA Manual.
Regular and predictable attendance is an essential requirement of this position
Attend meetings as assigned by the Quality Assurance Manager, actively participate, and share detailed notes and insights with the team.
Other duties as assigned.
Education and/or Experience:
Demonstrated experience with Medi-Cal billing and EHR System.
Two (2) years of office work experience with attention to details.
Certificates, Licenses, Registrations:
Possess a valid California Driver’s License and current vehicle insurance. Driving records must meet, and continue to meet, the underwriting standards established by the generalized driving guidelines used by our insurance broker.
Must provide proof of insurance.
Must have at least 3 or more years of driving experience.
Other Skills, Abilities, and Job Requirements:
Ability to pass clearance of the Federal Bureau of Investigation (FBI) and/or Department of Justice (DOJ) background screenings.
Consumer of mental health services or a family member of a mental health consumer is desirable.
Work overtime as requested and approved.
HOPE Cooperative (aka TLCS, Inc.) is an Aff…
#J-18808-Ljbffr
4 days ago Requisition ID: 2984
Are you a motivated individual with a passion for supporting others and making a difference in the community? Hope Cooperative is a highly respected, award-winning nonprofit provider of a full array of mental health and supportive housing services in Sacramento County, and we need you to bring your compassion and support to the most vulnerable in our community. We are looking for dynamic, committed individuals to join our team!
Title:
Quality Assurance Specialist
Program(s) and Location:
Quality Assurance (Sacramento, CA)
Schedule:
Full-time non-exempt, 40 hours/week, Monday- Friday 8:00am-4:30pm
Pay rate:
$24.14/hour
Benefits:
HOPE Cooperative (aka TLCS, Inc.) offers a competitive benefits package consisting of, but not limited to, the following, and may be subject to change:
21 PTO days per year (4 weeks & 1 day)
26 PTO days after the 5 th year (5 weeks & 1 day)
11 paid holidays
1 Personal Day
Leadership Development!
Reimbursements!
Eligible for Government Loan Forgiveness Programs
Employer-paid health insurance for employees and children (Kaiser, Sutter or Western Health Advantage)
HSA Contributions
Flexible Spending Account
PTO Cash Out
Voluntary Dental, Vision, Life Insurance, Accident Insurance, Disability Insurance and more
Employee Assistance Program
Regular wage step scale increases
Flexible start/end times for some positions
iPhone with unlimited data for personal/professional use and laptop for some positions
Clinical Supervision towards licensure (for certain positions and upon approval)
CEU days for certain positions
Up to $500 CEU allowance for certain positions
Annual BBQ and staff appreciation awards
Annual Gift Card Program
* All benefit offerings are subject to change and are governed by the eligibility guidelines in the Employee Handbook. This list represents a general summary of available benefits and nothing stated here should be interpreted as being included in a written offer for employment.
Position Description:
The Quality Assurance Specialist, reporting to the Quality Assurance Manager, ensures accuracy, compliance, and efficiency across the organization’s Medi-Cal billing programs. This role supports the revenue cycle by reviewing claims, identifying errors, monitoring billing trends, and ensuring adherence to payer rules, coding guidelines, and internal standards. The Specialist also monitors the quality of services provided through routine chart audits, ensuring compliance with organizational standards and county requirements. The ideal candidate is detail-oriented, highly organized, and experienced in behavioral health billing practices.
Essential Duties and Responsibilities:
(includes the following; other duties may be assigned)
Review and update clients’ Medi-Cal eligibility on a monthly basis, and prepare and distribute an eligibility spreadsheet to the assigned program to ensure accurate billing and timely reimbursement.
Process medical record requests
from a variety of agencies—including Social Security, attorneys, courts, physicians, and individuals—while ensuring strict adherence to all
HIPAA-compliant guidelines and confidentiality regulations .
Provide feedback, training, and quality improvement recommendations to billing staff, clinicians, and administrative teams.
Collaborate with billing leadership to refine workflows, enhance quality standards, and support ongoing process improvement initiatives.
Identify trends, errors, or process gaps that lead to denials, delays, or billing inconsistencies.
Act as a designated Mandated Reporter, fulfilling the responsibility to report suspected abuse or neglect of children, dependent adults, disabled individuals, and seniors. This includes adhering to the "Duty to Warn" protocols by notifying authorities and potential victims of threats of physical harm.
Ensure the protection and confidentiality of all Protected Health Information (PHI) by following all policies and procedures in the HIPAA Manual.
Regular and predictable attendance is an essential requirement of this position
Attend meetings as assigned by the Quality Assurance Manager, actively participate, and share detailed notes and insights with the team.
Other duties as assigned.
Education and/or Experience:
Demonstrated experience with Medi-Cal billing and EHR System.
Two (2) years of office work experience with attention to details.
Certificates, Licenses, Registrations:
Possess a valid California Driver’s License and current vehicle insurance. Driving records must meet, and continue to meet, the underwriting standards established by the generalized driving guidelines used by our insurance broker.
Must provide proof of insurance.
Must have at least 3 or more years of driving experience.
Other Skills, Abilities, and Job Requirements:
Ability to pass clearance of the Federal Bureau of Investigation (FBI) and/or Department of Justice (DOJ) background screenings.
Consumer of mental health services or a family member of a mental health consumer is desirable.
Work overtime as requested and approved.
HOPE Cooperative (aka TLCS, Inc.) is an Aff…
#J-18808-Ljbffr