CalAIM Revenue Cycle Manager

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 Rather than focusing on archaic outdated design we strive to consistently question the status-quo and create new and more innovative ways to help aging adults and adults with disabilities maintain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 organizations 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.

Essential Duties & Responsibilities

The following statements describe the primary responsibilities of this position and are not intended to be an exhaustive list of all duties.

• 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.

Required Qualifications

• Bachelors 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.

Preferred Qualifications

• 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.

Compensation

• Range:$120000 - $125000/annual

This amount is not necessarily reflective of actual compensation that may be earned nor a promise of any specific pay for any specific employee which is always dependent on actual experience education and other factors.

This range does not include any additional equity benefits or othernon-monetarycompensation which may be included.