CalAIM Revenue Cycle Manager

Institute on Aging•San Francisco, CA

About The Position

IOA is on the forefront of revolutionary healthcare models, reshaping the way people can age in place. Our innovative models transform lives, enhance communities, and save healthcare systems millions of dollars. Rather than focusing on archaic outdated design, we strive to consistently question the “status-quo” and create new and more innovative ways to help aging adults and adults with disabilities maintain their quality of life. With over 23 programs, we offer multiple ways to aid seniors maintain their health, well-being, independence and participation in the community, fulfilling our mission. The CalAIM Revenue Cycle Manager is responsible for leading the organization's CalAIM billing and accounts receivable operations, ensuring timely and accurate reimbursement from Medi-Cal Managed Care Plans (MCPs), commercial payers, and other funding sources. This position oversees the entire lifecycle of a claim, from initial encounter data capture to final payment. It including Enhanced Care Management (ECM) and Community Supports (CS), while driving operational excellence, regulatory compliance, denial reduction, and cash flow optimization. The Manager partners closely with Accounting, Finance, Operations, and Program Leadership to strengthen billing processes and maximize reimbursement.

Requirements

Bachelor's degree in Healthcare Administration, Business Administration, Accounting, Finance, or a related field, or an equivalent combination of education and experience.
Five (5) or more years of progressive healthcare revenue cycle, medical billing, or accounts receivable experience.
At least two (2) years of leadership or supervisory experience overseeing billing or revenue cycle staff.
Demonstrated expertise in Medi-Cal Managed Care, CalAIM billing, and commercial payer reimbursement.
Proven success managing claim submissions, denial management, appeals, authorization processes, and accounts receivable recovery.
Strong knowledge of healthcare revenue cycle operations, payer regulations, and reimbursement methodologies.
Proficiency with EMR/EHR systems, billing software, and Microsoft Excel, including reporting and data analysis.
Strong analytical, organizational, leadership, and project management skills.
Excellent written, verbal, and interpersonal communication skills with the ability to collaborate across departments.

Nice To Haves

Direct experience supporting CalAIM programs, including Enhanced Care Management (ECM) and Community Supports (CS).
Experience managing billing operations for home health, community-based services, behavioral health, or value-based care programs.
Experience implementing revenue cycle process improvements and performance metrics.
Knowledge of healthcare compliance, payer audits, and revenue integrity best practice.
Professional certification such as Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), or a related credential is preferred.

Responsibilities

Lead the day-to-day operations of the CalAIM billing, claims, and accounts receivable functions, ensuring timely, accurate, and compliant claims submission, payment posting, denial management, appeals, collections, and reimbursement.
Supervise, coach, and develop billing and claims staff by establishing performance expectations, monitoring productivity, and fostering a culture of accountability and continuous improvement.
Monitor revenue cycle performance, including claims, denials, reimbursement, accounts receivable aging, cash collections, and key performance indicators (KPIs); analyze trends, identify root causes, and implement corrective actions to improve financial outcomes.
Ensure compliance with CalAIM, DHCS, Medi-Cal, payer contracts, and applicable federal, state, and organizational policies and billing requirements.
Serve as the primary liaison with Managed Care Plans (MCPs) and other payers to resolve complex billing, authorization, eligibility, encounter, payment, and reimbursement issues.
Partner with Operations, Clinical, and Program Leadership to improve documentation, billing accuracy, workflow efficiency, internal controls, and reimbursement performance.
Support financial operations by calculating and reporting monthly revenue, assisting with revenue recognition, reconciliations, audits, month-end close, budgeting, forecasting, audits, and regulatory reporting.
Lead revenue cycle process improvements, system enhancements, payer onboarding, and implementation of new CalAIM programs and billing workflows.
Develop, maintain, and enforce departmental policies, procedures, and training to ensure operational consistency, compliance, and best practices.
Perform other duties, special projects, and related responsibilities as assigned.