Social Services Jobs in San Jose, CA (Now Hiring) — 492 open — Page 10

Monday through Friday 8:00am - 4:30pm OR 6:00am - 2:30pm

The pay range is $75K - 95K per year depending on the relevant years of experience.

We offer a competitive package of employee benefits for 30 to 40-hour week positions. You will receive a defined contribution amount of up to $15,433.08 per year (prorated for part-time employees working less than 40 hours per week) to purchase the benefits of your choice on a cafeteria plan basis. Any amount of this defined contribution not used towards your benefits will be paid to you as taxable earnings. We offer a retirement plan with a generous employer match starting at 4% after one year of employment.  Our paid time off is also more generous than many employers with vacation time accruing up to 25 days per year, 6 days of sick time per year and 12 paid holidays.

The benefits offered in our cafeteria plan are as follows: 

• Medical benefits –Kaiser--ranging from $0 Deductible Plan with $15 Copay to $,3400 Deductible Plan with Health Savings Account. Sutter Health plans are also available from $0 Deductible Plan to $2,500 Deductible Plan.
• Dental benefits –Guardian: 1 dental HMO and 2 PPOs
• Vision benefits – 2 options from Guardian VSP: a standard vision plan and an enhanced vision plan

Position Summary

The Revenue Cycle Analyst is responsible for the full lifecycle management of Momentum’s reimbursement activities, including billing, denial management, accounts receivable follow-up, payment reconciliation, reimbursement analysis, and collections. This position will be a subject matter expert in behavioral health billing regulations, Santa Clara County behavioral health reimbursement requirements, Medi-Cal claim methodologies, managed care billing, and electronic health record systems, such as my Avatar. Working independently, the Revenue Cycle Analyst proactively identifies revenue cycle issues, researches root causes, develops corrective actions, and collaborates with clinical, program leads, program administrators, finance, quality, and operational teams to maximize reimbursement and ensure regulatory compliance. This role functions as a high-level individual contributor with ownership of assigned revenue cycle processes from issue identification through final resolution.

Essential Duties and Responsibilities

1. Revenue Cycle Management
   1. Manage behavioral health billing and reimbursement processes from claim generation through payment collection
   2. Analyze and resolve complex billing issues, claim edits, denials, underpayments, and rejected claims
   3. Research reimbursement discrepancies and implement corrective actions to prevent recurring issues
   4. Monitor claim submission activity and ensure timely filing compliance
   5. Conduct comprehensive accounts receivable analysis and prioritize collection activities
   6. Follow claims from point of service through final payment resolution
2. Denial Management
   1. Independently investigate and resolve denied or rejected claims
   2. Identify root causes of denial trends and develop corrective action plans
   3. Prepare and submit appeals and supporting documentation
   4. Track appeal outcomes and recovery performance
   5. Partner with clinical, quality, and program staff to reduce future denials
3. Financial Analysis and Reconciliation
   1. Create, review, and post payments, adjustments, transfers, and contractual allowances
   2. Validate reimbursement accuracy based on payer contracts and county funding requirements
   3. Analyze revenue trends and billing patterns
   4. Conduct bi-weekly accounts receivable analytics and aging reviews
   5. Prepare financial and operational reports with recommendations for leadership
4. Behavioral Health and County Billing Expertise
   1. Maintain expertise in:
      1. Medi-Cal Specialty Mental Health Services
      2. Santa Clara County Behavioral Health Services requirements
      3. CalAIM initiatives
      4. Behavioral health documentation requirements
      5. Managed Care billing guidelines
      6. Federal and State reimbursement regulations
   2. Interpret county claiming requirements and communicate operational impacts to leadership and program teams
   3. Collaborate with county representatives and commercial payers to resolve reimbursement issues
5. EHR and System Support
   1. Serve as a subject matter expert for revenue cycle processes within:
      1. myAvatar EHR
      2. Inovalon
      3. Other behavioral health EHR platforms
   2. Identify workflow gaps impacting reimbursement
   3. Participate in system implementation, testing, upgrades, and optimization projects
   4. Develop recommendations to improve billing efficiency and revenue capture
6. Revenue Integrity and Compliance
   1. Conduct audits of clinical documentation and billing data to ensure claim accuracy
   2. Identify compliance risks related to billing and reimbursement activities
   3. Partner with clinical and quality teams to improve documentation supporting medical necessity and billing requirements
   4. Ensure compliance with federal, state, county, payer, and agency regulations.
7. Cross-Functional Collaboration
   1. Act as a billing and reimbursement resource for program managers, leadership, clinicians, and finance staff
   2. Train staff on reimbursement requirements, documentation standards, and billing workflows
   3. Participate in process improvement initiatives designed to increase cash collections and reduce denials
   4. Lead revenue cycle projects and special assignments as directed

Education and Experience

1. BS Degree in Accounting, Finance, Business Administration, Health Information Management, Healthcare Administration, or related field; OR equivalent combination of education and relevant healthcare revenue cycle experience
2. Minimum 3-5 years of healthcare billing, reimbursement, revenue cycle, or accounts receivable experience
3. Experience independently resolving claim denials, payment variances, and aging accounts receivable
4. Preferred Experience
   1. Experience billing Santa Clara County Behavioral Health programs
   2. Experience with Specialty Mental Health Services (SMHS)
   3. Experience with Medi-Cal, Medicare, and Managed Care reimbursement
   4. Experience using myAvatar EHR
   5. Experience interpreting payer contracts and reimbursement processes
   6. Experience performing payment reconciliation and revenue analysis
   7. Experience with behavioral health, mental health, substance use disorder, or community healthcare services
5. A valid California driver’s license, current automobile insurance, and a good driving record, as documented by a DMV report.
6. Physical requirements needed to perform the essential functions of this job, with or without accommodation: Hearing and talking on telephone and in person; standing, walking, sitting, pinching and finger flexion are required constantly (over 2/3 of the workday); (E) Lifting, carrying, pushing, pulling, bending, stooping, crouching, kneeling and twisting are required occasionally (under 1/3 of the workday); (E) Balancing, climbing and crawling are generally not required.

Knowledge, Skills and Abilities

1. Technical Expertise - Advanced understanding of:
   1. Revenue Cycle Management
   2. Healthcare Accounts Receivable
   3. Denial Management
   4. Behavioral Health Billing
      1. Medi-Cal Billing Requirements
      2. Payment Posting
      3. Managed Care Reimbursement
      4. Financial Reconciliation
      5. Revenue Integrity Principles
2. Analytical Skills:
   1. Strong root-cause analysis and problem-solving abilities
   2. Ability to independently research and resolve complex reimbursement issues
   3. Ability to identify trends and recommend operational improvements
   4. Strong quantitative and accounting skills
3. Systems Proficiency - Advanced Microsoft Excel skills, including:
   1. Pivot Tables
   2. VLOOKUP/XLOOKUP
   3. Financial analysis functions
4. Experience with:
   1. myAvatar
   2. Claims clearinghouses (ChangeHealthcare/Inovolan)
   3. Revenue cycle processes
   4. Financial reports creation and analysis
5. Communication:
   1. Ability to effectively communicate reimbursement and financial concepts to both operational and clinical staff
   2. Strong written and verbal communication skills
   3. Ability to influence process improvements across departments
6. Core Competencies:
   1. Revenue Cycle Expertise
   2. Accountability
   3. Critical Thinking
   4. Financial Acumen
   5. Problem Solving
   6. Data Analysis
   7. Attention to Detail
   8. Customer Service
   9. Regulatory Compliance
   10. Process Improvement
   11. Initiative
   12. Independent Judgment
   13. Collaboration