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

TLCS, Inc.

2d•$24

About The Position

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.

Requirements

Demonstrated experience with Medi-Cal billing and EHR System.
Two (2) years of office work experience with attention to details.
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.
Ability to pass clearance of the Federal Bureau of Investigation (FBI) and/or Department of Justice (DOJ) background screenings.

Nice To Haves

Consumer of mental health services or a family member of a mental health consumer is desirable.
Work overtime as requested and approved.

Responsibilities

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.

Benefits

21 PTO days per year (4 weeks & 1 day)
26 PTO days after the 5th year (5 weeks & 1 day)
6 days paid sick time
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
401k match
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
Referral Bonuses