CalAIM Billing and Coding Manager

SALARY:
$103927.20 - $132629.12 Annually

THE POSITION:
Under general direction this role will conduct coding audits provide ongoing education to Wellpath billing service providers and ensure adherence to CPT HCPCS ICD-10 and CalAIM coding requirements. The position is responsible for analyzing coding trends identifying opportunities for improvement developing training programs and supporting revenue cycle management while maintaining full compliance with federal state and County regulations. The ideal candidate will have extensive experience in medical coding and billing compliance strong analytical and organizational skills and the ability to effectively lead training and collaborate with internal teams and external partners.

All County leaders are expected to uphold the values of accountability customer-focus and efficiency. Incumbents lead others and model behaviors that exemplify quality customer service; provide effective and ethical leadership; creatively and strategically plan develop and implement programs that use human and financial resources to achieve results; are accountable for strategy and goal formation consistent with the Countys mission and key business objectives; engage stakeholders; communicate and collaborate effectively at multiple levels; develop employees; analyze issues and data; and efficiently use public resources.

THE PROGRAM:

The CalAIM (California Advancing and Innovating Medi-Cal) initiative is a multi-year effort by the California Department of Health Care Services to transform Medi-Cal into a more coordinated person-centered equitable health system. CalAIM expands and integrates services that address physical behavioral and social needs improves access to care reduces disparities and supports whole-person health for Medi-Cal members across the lifespan. Local implementation aligns with state goals to enhance care management address social determinants of health and strengthen outcomes for vulnerable populations.

IDEAL CANDIDATE WILL POSSESS:

• Extensive knowledge of CPT HCPCS ICD-10 and Medi-Cal/CalAIM Justice Involved coding requirements including documentation standards and billing regulations.
• Experience conducting medical coding audits identifying discrepancies and providing constructive feedback to improve accuracy and compliance.
• Demonstrated skill in developing and delivering training programs including creating clear instructional materials and providing one-on-one coaching.
• Strong analytical abilities to review coding data identify trends assess risk areas and prepare clear actionable reports for leadership.
• Familiarity with healthcare regulatory requirements including CMS and state billing guidelines.
• Excellent written and verbal communication skills with the ability to explain complex coding concepts to diverse audiences.
• Strong organizational and time-management skills including the ability to manage multiple ongoing audits training schedules and project deadlines.
• Ability to build positive working relationships with medical staff billing service providers contractors and internal teams.
• A proactive solutions-oriented approach to identifying operational issues and implementing process improvements.
• Commitment to accuracy high-quality data and ensuring full compliance in support of effective revenue cycle management.
• Professionalism discretion and strong customer-service skills when interacting with internal and external partners.

DISTINGUISHING CHARACTERISTICS:
This is the third (advanced journey) level in the Management Professional job family. This class is distinguished from subordinate classes within the series by the greater level of responsibility assumed complexity of duties assigned independence of action taken and by the nature impact and scope of the public contact. Incumbents in this job class perform the most difficult and responsible types of duties assigned to classes within this series. Incumbents at this level are required to be fully trained in all policies procedures and operations related to assigned areas of responsibility.

SUPERVISION RECEIVED AND EXERCISED
Reports to the department Chief Financial Officer (CFO). Oversees the work of a team or teams of individual contributors through subordinate managers. May exercise direct and indirect supervision over assigned management professional technical and administrative staff.

THE DEPARTMENT:

County of Santa BarbaraHealth: Our mission is to improve the health of our communities by preventing disease promoting wellness and health equity while ensuring access to needed health care and maintaining a safe and healthy environment. Our vision is healthy people healthy community healthy environment. With a staff of 550 and a budget of approximately $120 million County Health serves a population of about 445000 residents in Santa Barbara County.

For more information please visit: Hereto learn more about the County of Santa Barbara Health Department
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BENEFITS:

The County of Santa Barbara offers generous benefits. Click on the Benefits Tab above orclick here to view more addition applicants from other public sector employers may qualify for:

• Retirement reciprocity
• Time and service credit towards an advanced vacation accrual rate

These examples are not intended to reflect all duties performed within the job and not all duties listed are necessarily performed by each individual.

• Reviews medical records and documentation to ensure accurate and compliant use of CPT HCPCS ICD-10 and CalAIM Justice Involved code sets.
• Conducts routine and targeted coding audits including monthly reviews of medical encounters for each Wellpath billing service provider; identifies errors discrepancies and potential compliance issues; and provides corrective feedback.
• Develops delivers and maintains a comprehensive medical coding training program for Wellpath billing service providers including presentations manuals job aids and one-on-one training sessions.
• Provides ongoing training on coding updates documentation requirements regulatory changes and industry best practices; supports providers in improving coding accuracy and documentation quality.
• Analyzes coding and billing data to identify trends risk areas and opportunities for improvement; prepares detailed audit reports and presents findings to management and stakeholders.
• Participates in the development and review of policies procedures and standards related to coding documentation billing operations and revenue cycle compliance.
• Supports operational strategies by identifying and resolving documentation or workflow issues recommending improvements and monitoring corrective action plans.
• Plans and implements special projects and initiatives aligned with CalAIM and County Health goals; coordinates activities with internal teams contractors and external partners.
• Builds and maintains positive working relationships with Wellpath billing providers department staff consultants and external agencies using principles of excellent customer service.
• Represents the department in meetings trainings and discussions with internal and external partners regarding coding practices compliance requirements and audit findings.
• May oversee or coordinate the work of consultants or staff including setting expectations reviewing deliverables and ensuring project quality and timelines.
• Conducts research and prepares reports presentations and recommendations related to coding operations documentation standards regulatory impacts and program performance.
• Maintains current knowledge of CPT HCPCS ICD-10 CMS HIPAA CalAIM Justice Involved guidance and other applicable state and federal regulations; evaluates how changes impact County Health operations and recommends appropriate actions.
• Performs other related duties as required.

Education and Experience

The knowledge skills and abilities listed below may be acquired through various types of trainingeducation and experience. A typical way to acquire the required knowledge and abilities would be:

• Equivalent of a bachelors degree from an accredited four-year college or university a field related to Medical Billing Health Information Management and/ or Finance; AND

• Four (4) years of progressively responsible experience involving planning analysis coordination and evaluation in a field related to Medical Billing Health Information Management and/ or Finance.

Licenses and Certificates
For specific positions possession and maintenance of a valid California drivers license and the ability to meet automobile insurability requirements of the County or the ability to provide suitable transportation needs as a condition of continued employment.

Additional Requirements:

• May be required to work a varied schedule of hours which may include evenings weekends and holidays.
• Completion of a background investigation to the satisfaction of the County may be required for some assignments.

Knowledge of:

• Principles and practices of leadership motivation team building and conflict resolution.
• Standard and accepted methods of writing requests for proposals selecting consultants and negotiating contracts.
• Principles and practices of public administration and principles of organization management and staffing.
• Pertinent local state and federal laws guidelines regulations and statutes.
• Principles and practices of public finance budgeting and fiscal control.
• Principles and practices of public human resources.
• Principles and techniques to plan develop and coordinate comprehensive local government public relations communications and media relations programs.
• Standard research techniques including the use of surveys and questionnaires.
• Principles and techniques of administrative analysis including workload measurement workflow and layout work simplification and systems and procedure analysis.
• Principles and practices of local government including county administration organization programs and functions.
• Modern office procedures methods and computer equipment.
• Computer software including word processing spreadsheet presentation and database applications.
• English usage spelling punctuation and grammar.

Ability to:

• Read analyze evaluate and summarize written materials and statistical data including reports financial reports and budgets.
• Compose coordinate and edit a variety of educational informational and promotional materials for dissemination and use by the County other agencies news media and the general public.
• Apply the principles and practices of motivation team building and conflict resolution.
• Obtain information through interview process; successfully accomplish multiple assignments; deal firmly and courteously with the public.
• Determine effective method of research; compile data and present it in a form most likely to enhance understanding.
• Prepare reports statistical data forms questionnaires and surveys.
• Analyze problems identify alternative solutions project consequences of proposed actions and implement recommendations in support of goals.
• Interpret and apply pertinent local state and federal laws and regulations.
• Analyze situations quickly and objectively apply appropriate elements of decision making and determine the proper course of action.
• Effectively deal with high levels of ambiguity and possess the ability to navigate through the ambiguity.
• Exercise initiative sound independent judgment tact sensitivity and discretion and maintain confidentiality within established guidelines.
• Collaborate with various community groups in a tactful and effective manner.
• Communicate clearly and concisely both orally and in writing.
• Make effective presentations to the community and the media.
• Understand interpret explain and apply complex rules and procedures.
• Analyze systems and administrative and management practices and identify opportunities for improvement.
• Establish and maintain effective working relationships with a diverse range of individuals including but not limited to coworkers subordinate staff supervisors other managers professional agencies and the general public.

APPLICATION & SELECTION PROCESS

1. Review applications and supplemental questionnaireto determine those applicants who meet the employment standards.
2. Supplemental Questionnaire Ranking.Responses to the required examination supplemental questions will be evaluated and scored. Candidates final score and rank on the eligibility list will be determined by the responses to these questions. This process may be eliminated if there are fewer than 11 qualified candidates.

Candidates must receive a percentage score of at least 70 on the supplemental questionnaire ranking to be placed on an employment list. An adjustment may be made to raw scores based on factors listed in Civil Service Rule VI. Those candidates who are successful in the selection process will have their names placed on the employment list for a minimum of three months. At the time the employment list is established all candidates will receive an email notice of their score on the exam(s) rank on the employment list and exact duration of the employment list.

REASONABLE ACCOMMODATIONS:The County of Santa Barbara is committed to providing reasonable accommodation to applicants. Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter listed on the job posting. We require verification of needed accommodation from a professional source such as a Medical Provider or a learning institution.

Recruiters will communicate with applicants by e-mail during each step in the recruitment process. Applicants are reminded to check spam filters continuously during the Recruitment & Selection Process steps listed above to ensure they do not miss required deadlines.

County of Santa Barbara Health (County Health) requires all employees working in direct contact with patients or clients in a high-risk environment to comply with the County Health Employee Immunizations policy. This can be accomplished by providing documentation of immunizations submitting laboratory immune titers demonstrating adequate immunity or obtaining required vaccinations. A list of requirements based on the specific program will be sent at the time an offer letter is presented to the selected candidate(s) and initial documentation will be required at this time.

Completion of a background investigation to the satisfaction of the County may be required for some assignments.

Disaster Service Worker: Pursuant to Governmental Code section 3100 all employees with the County of Santa Barbara are declared to be disaster service workers subject to such disaster service. Activities as may be assigned to them by their superiors or by law.

EQUAL EMPLOYMENT OPPORTUNITY (EEO) STATEMENT
The County of Santa Barbara provides equal employment opportunities to all employees and applicants and prohibits discrimination harassment and retaliation of any type with regard to any characteristic or status protected by any federal law state law or Santa Barbara County ordinance. The County continues to be committed to a merit-based selection process and to eliminating barriers to attracting and retaining top qualified candidates. The County has a long-standing practice of providing a work environment that respects the dignity of individual employees and values their contributions to our organization.

APPLICATION AND SUPPLEMENTAL QUESTIONNAIRE DEADLINE:02/17/2026at 4:59 PM PST. Applications and job bulletins can be obtained 24 hours a day at .