Director of Quality Assurance and Compliance

Vista Del Mar • Los Angeles, CA

5d

About The Position

To ensure efficient, timely, and competent performance of all quality-related personnel and administrative staff in the agency as related to quality assurance, billing and compliance issues. This individual is responsible for assuring that the quality standards for the agency are met as measured by timely and accurate billing, compliance with outside payors and audit readiness by licensing and accrediting bodies and that these functions are acting in a coordinated manner in the service to the clients and the Agency. This individual is responsible for representing Vista Del Mar at various meetings and committees.

Requirements

• Billing Experience
• Claims experience - In PSYCH/MENTAL HEALTH is a preference. NO commercial, banking, retail will be considered
• Department of Mental Health
• CalAIM Behavioral Health Payment Reform
• Experience managing administrative operations (billing, scheduling, recordkeeping, workflow).
• Leadership or supervisory experience in healthcare, behavioral health, or social services.
• Professionalism and maturity in client and staff interactions.
• Strong discretion and confidentiality in handling sensitive information (HIPAA/FERPA compliant).
• Familiarity with LACDMH systems and CalAIM initiatives (July 2024–present).
• Knowledge of Medi-Cal billing and Medicaid compliance (state/federal).
• Understanding of CDSS licensing standards for child and family services.
• Working knowledge of Title 22 & Title 9 (California Code of Regulations).
• Experience with EHR systems and healthcare billing platforms.
• Knowledge of regulatory/accrediting bodies (e.g., Joint Commission, CARF).
• Strong judgment and decision-making in clinical/business environments.
• LA COUNTY DEPT OF MENTAL HEALTH (DMH) AND DEPT OF CHILD AND FAMILY SERVICES (DCFS) - must be experienced in this area for consideration.
• Must have visual, physical and technical ability to do bookkeeping, to be computer literate, to independently use a photocopier, Microsoft Word and Excel and PC. Must be able to effectively verbally communicate with staff and clients.
• Qualifications to manage a $40 million dollar budget.
• College degree preferred but mandatory.
• 7 years previous related experience with contract management and revenue reporting.
• Experience with electronic health records transition (CalAIM)

Responsibilities

• Distribution of work assignments, staffing, supervision, monitoring and evaluating of all staff and services under Quality and Compliance
• Manages the reconciliation of the agency's DMH contract ensuring timely reporting of revenue, monitoring the claim denials and voids. Ensures accuracy of all claims submitted regarding procedure, funding and credential codes. Provides revenue, utilization and ad hoc reports to staff and works with programs to maximize funding challenges. Works with agency leads and DMH Contract Monitoring and Management Division providing reports as needed to request funding shifts or additional funds.
• Oversees Contracts Compliance Manager to ensure that contracts related to clinical services and programs are monitored for compliance, negotiation for individual client contracts with other counties and entities are completed timely, and that new opportunities are monitored and shared with staff for review and consideration.
• Manages DMH Quality Assurance and Revenue Management compliance projects that include, but not limited to, Medi-Cal Certification of all program sites, Annual Quality Assurance Reporting and Void Reports. Provides claims, revenue and credential reporting back up as needed for DMH compliance reporting.
• Oversee the Financial Manager ensuring revenue from all QSC responsible contracts is recorded accurately and timely to accounting, budgets for negotiated individual client contracts accurately reflect services to be provided and billed timely.
• Oversee Regulatory Compliance and Health Information Manager and the responsibilities for development and maintenance of the agency's electronic health record systems, the functions of the Quality Assurance Programs and the establishment of protocols for effective maintenance and monitoring of clinical case records. Ensures client PHI is maintained in compliance with HIPAA standards and accreditation requirements.
• Oversee performance improvement tasks identified and developed around quality assurance and contract compliance issues ensuring they are developed, implemented and completed timely, that trends and results are used for program improvement, that VDM is HIPAA compliant, and that the Agency is audit ready for all contract and accreditation reviews.
• Oversee the Billing Manager and the management of client information and claims submission to Insurance and Contracts accurately and in compliance with contractual obligations, including the correction and resubmission of rejected, denied and unbilled claims.
• Directly supervises quality management, billing and contract staff in the department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Benefits

• Full benefits offered (Medical, Dental, Vision)
• FSA/Dependent Care and Supplemental benefits through The Standard
• 403(b) – 3% Employer contribution based off annual salary
• 4 Mental Health Days
• Up to 12 Paid Holidays
• Up to 25% for Cell Phone Discounts with 3 Major Carriers (AT&T, Verizon, Sprint)

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 501-1,000 employees