AGENCY DESCRIPTION:  

Instituto Familiar de la Raza, Inc. is a multi-service community health and social service agency with an emphasis on serving the Chicano/Latino/Indígena community in San Francisco with a special focus on the diverse needs of the Mission District. Services include a wide range of mental health, HIV-related services, and social services, including health promotion, education, prevention, early intervention, case management, psychological and psychiatric interventions, and cultural/social and spiritual re-enforcement. The agency serves children, youth, adults, and families. It has a rich history of working collaboratively with other agencies to meet the needs of the Chicano/Latino/Indígena community and other cultural/racial communities in San Francisco.

PROGRAM/POSITION DESCRIPTION:  

CalAIM Enhanced Care Management (ECM) is a patient-centered program under California’s CalAIM (California Advancing and Innovating Medi-Cal) initiative, designed to provide comprehensive, whole-person care to Medi-Cal beneficiaries with complex health and social needs. The ECM program focuses on high-risk populations, such as individuals with multiple chronic conditions, serious mental health and substance use needs, or those experiencing homelessness, by offering intensive, coordinated care management and other services. Through a team-based approach, ECM program staff work closely with members, healthcare providers, and community organizations to address the medical, behavioral, and social determinants of health, connecting members to vital resources such as housing support, behavioral health services, and social services. The goal of ECM is to improve health outcomes, reduce health disparities, and promote better health and stability for vulnerable populations in our community.

The CalAIM Enhanced Care Management (ECM) Billing Specialist is responsible for supporting the billing, data management, and reporting processes specifically for CalAIM and ECM initiatives. This role ensures accurate tracking, billing, and reporting of services rendered under the CalAIM program, with a focus on compliance and program integrity. The ideal candidate will have a strong background in healthcare billing, an understanding of Medi-Cal regulations, and the ability to analyze and validate complex data sets. This position is essential for ensuring that CalAIM-ECM services are billed correctly, claims are processed efficiently, and data is leveraged for strategic decision-making.

Essential Job Duties include but are not limited to the following:  

Billing & Claims Management

• Prepare, review, and submit CalAIM-ECM billing claims, ensuring compliance with Medi-Cal requirements and program guidelines.
• Verify and reconcile data related to member services, ensuring all documentation is complete and accurate prior to claim submission.
• Identify, research, and resolve billing discrepancies, working closely with the ECM team and finance department.
• Monitor claims status, track denials, and follow up to ensure timely payment and resolution of billing issues.

Data Coordination and Reporting

• Maintain comprehensive records of CalAIM-ECM services, tracking utilization, service delivery, and outcomes.
• Extract, validate, and analyze data from multiple sources to generate detailed reports for internal and external stakeholders.
• Assist in developing monthly, quarterly, and annual reports for program performance and compliance reviews.
• Provide data insights to support strategic planning and program evaluation.

Compliance and Program Integrity

• Ensure billing practices adhere to all applicable state and federal regulations, including Medi-Cal and CalAIM program requirements.
• Participate in audits and compliance reviews, preparing necessary documentation and responding to inquiries from auditors.
• Maintain an up-to-date understanding of CalAIM-ECM requirements, including changes in reimbursement policies and procedures.

Collaboration and Communication

• Act as a liaison between the billing, ECM, and Compliance teams to ensure accurate data sharing and alignment.
• Collaborate with internal teams to identify process improvements and implement best practices for data management and billing workflows.
• Serve as the point of contact for billing-related inquiries, providing support to program staff, providers, and external partners.

System Maintenance and Data Integrity

• In Coordination with the IT department, manage and update billing software, ensuring accurate setup of service codes and reimbursement rates for CalAIM ECM services.
• Monitor and maintain data integrity within the Electronic Health Record (EHR) system and other tracking tools.
• Support system upgrades and testing, ensuring new features and configurations are aligned with billing requirements.

All other relevant duties as assigned

REQUIRED SKILLS:

• Proficiency in billing software and Microsoft Excel (advanced functions, pivot tables, data validation).
• Strong attention to detail and ability to manage large data sets accurately.
• Knowledge of Medi-Cal reimbursement guidelines and experience with state-funded healthcare programs.
• Excellent problem-solving skills, with the ability to troubleshoot billing and data issues independently.
• Effective communication skills, both written and verbal.
• Efficient time management skills and ability to manage own workflow.
• Strong team player; ability to collaborate with diverse individuals within all levels of an organization.

PREFERRED SKILLS:

• Experience working with CalAIM or Enhanced Care Management programs.
• Familiarity with managed care programs or Medi-Cal regulatory requirements.
• Certification in healthcare billing, coding, or data analytics.
• Experience with Electronic Health Record (EHR) systems and financial data systems.
• Experience working within health care system and a non-profit community agencies.
• Knowledge of database programs such as EPIC.

EDUCATION, CERTIFICATION AND LICENSES

• Preferred Bachelor’s Degree Healthcare Administration, Business, Accounting, or a related field
• 2-years of work experience in healthcare billing, financial data management, or a related role.

CONDITIONS OF CONTINUED EMPLOYMENT

• Conduct annual Tuberculosis Test
• Must pass Department of Justice Fingerprint screening
• Must provide proof of COVID-19 Vaccination upon hire (Reasonable Accommodation Requests will be considered)

PHYSICAL DEMANDS:  

The physical demands described here represent what an employee encounters while performing the essential functions of this job. Reasonable accommodations can be made to enable individuals with disabilities to perform essential functions.  

• General ability to communicate effectively in person or via telephone in a manner that can be understood by those with whom the person is speaking too, including a diverse population  
• General alertness to address emergency or potentially dangerous situations   
• Requires physical ability to remain seated at a desk for long periods of time when needed 
• Basic manual dexterity to operate work processing equipment with skill, speed, and accuracy  
• Must be able to view computer for long periods of time  
• Ability to use public and/or private modes of transportation; duties are office-based, but travel to various  offsite venues is required  
• Activities that occur infrequently are: bending, squatting, crouching, kneeling, twisting, reaching straight, above  or below shoulders  
• On occasion, must lift up to 35 LBS 

COMPENSATION AND BENEFITS²  

The salary range for this position is $67,000 to $75,000 annually based on qualifications and experience. This is a full-time, exempt position at 35 hours a week with full benefits. The Billing Specialist will report directly to the ECM Program Manager.

All full-time positions at IFR are 35 hours per week and are eligible to participate in medical health benefit plans including dental, vision, 403(b) plan, earn vacation, sick leave, fourteen paid holidays, two paid days off (birthday and hire anniversary date) and ongoing learning opportunities.

TO APPLY:

Interested applicants should send an email to [email protected] addressed to the Human Resources Department, Instituto Familiar de la Raza, Inc. with “Billing Specialist – Enhanced Care Management Position” in the subject line and include the following files as attachments:

• A cover letter, indicating why you wish to join the Enhanced Care Management team and what makes you the ideal candidate.
• An up-to-date resume

Please note: a resume without a cover letter will not be considered.

Instituto Familiar de la Raza, Inc. (IFR) is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. For more information about your rights as an applicant, please see the U.S. Equal Employment Opportunity Commission poster.

For the complete nondiscrimination and affirmative action policy, please see the Civil Rights Department State of California's Discrimination, Harassment, and Affirmative Action in the Workplace policy.

² Please note that IFR reserves the right to change its benefits and contributions at any time at its sole discretion.