Position Summary
The CalAIM Specialist is the member of the Data and Systems Integration team responsible for the coordination, data entry and invoicing for CalAIM Community Supports programming. This position will ensure timely data entry and billing, monitor participant eligibility and status, coordinate with program staff and ensure that documentation is in compliance with contract guidelines. The CalAIM Specialist will collaborate with a multi-disciplinary team in exploring and implementing Community Supports and Enhanced Care Management (ECM). The CalAIM Specialist will work closely with program management and grants compliance.
Essential Functions
- Data Management: Monitor program enrollments, process Treatment Authorization Requests (TAR), follow up on claims, and ensure accurate and timely data entry and reporting.
- Financial Management: Process invoices, resolve claim denials, and maximize reimbursement.
- Operational Support: Contribute to project work plans, support technical assistance, and maintain program documentation.
- Quality Assurance: Monitor data quality, identify improvement areas, and ensure compliance with contract requirements.
- Training and Development: Create and deliver training materials, conduct training sessions, and support staff development.
- Program Coordination: Facilitate meetings, prepare agendas and minutes, and support contract audits and monitoring.
- Compliance: Adhere to confidentiality and HIPAA regulations and contribute to policy and procedure development.
- General Duties: Perform other assigned duties and participate in professional development.
- Mission and Values: Support the organization's mission, vision, and values in all job functions.
Note: Catholic Charities considers this position to be a mandated reporter of child abuse and elder abuse.
Other Responsibilities
Perform other related duties as assigned.
Agency Culture
It is essential that all employees of Catholic Charities aspire to the following:
- A commitment to the agency’s mission, vision, and values.
- A commitment to excellence in everything we do.
- A commitment to performance and quality improvement.
- A commitment to outcomes and measured results.
- A commitment to innovation and to what is possible.
Education, Experience & Skills Required
- Associate degree and two years’ work experience in a related field. Bachelor’s degree and at least 1-2 years’ experience in healthcare administration, medical billing, public health or a related field, preferred. An additional 4-6 years of direct work experience in a related field may be considered as a substitution for a degree.
- Strong knowledge of Cal-AIM services, Medi-Cal regulations, and compliance requirements.
- Demonstrated ability to set, manage, and hold integrity to timelines and deadlines.
- Ability to work collaboratively with diverse teams and handle sensitive information confidentially.
- Computer literacy required including experience with Microsoft 365 Suite, especially Excel, and SharePoint.
- Demonstrated ability to prioritize responsibilities and handle concurrent tasks and projects in various stages of completion.
- Experience working with various types of data and knowledge of the data life cycle from collection to reporting.
- Strong written and verbal communication; organization, conflict resolution and problem-solving skills.
- Excellent interpersonal skills, cooperative, friendly, proactive, and helpful attitude with clients and co-workers. Ability to work closely with other employees to ensure a positive and constructive environment within the program or department and throughout the Agency.
- Valid driver license and at least state required minimum of automobile insurance, clear DMV driving record and ability to provide own transportation. Must be willing and able to travel between agency sites.
- Must pass DOJ background clearance (fingerprinting) in accordance with the Diocese of Santa Rosa’s policies prior to start of employment.
- Bilingual (English/Spanish) preferred, but not required.
Job Analysis/Job Description Physical Requirements
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee frequently is required to reach with hands and arms and talk or hear. The employee is often required to stand, walk, travel, and stoop or bend. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to sit or stand for extended periods while using a computer.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Frequent incoming telephone calls, scanners, and copiers as well as a wide range of clients or at times clients in distress contribute to a noise level of average to above average.
Equal opportunity employer
Catholic Charities of the Diocese of Santa Rosa is an Equal Opportunity Employer, seeking the best and brightest. Our organization does not discriminate against or harass any employee or applicant for employment because of race, color, creed, religion, national origin, sex, disability, age, marital status, membership or activity in a local human rights commission, or status with regard to public assistance. We support, educate, create opportunities for, and ensure the wellbeing of our staff for the betterment of those most in need.
CCDSR participates in E-Verify, an Internet-based system that compares information entered by an employer from an employee’s Form I-9, Employment Eligibility Verification, to records available to the U.S. Department of Homeland Security and the Social Security Administration.
