Quality Assurance Specialist - Hope Cooperative; TLCS, Inc.

Quality Assurance Specialist - Hope Cooperative (TLCS, Inc.)

Full Time Professional Sacramento, CA, US

4 days ago Requisition

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…