Director of Revenue Cycle & Compliance (CalAIM)

Location: Stockton, California
Salary Range: $100,000–$130,000 annually
Employment Type: Full-Time, Direct Hire
Work Arrangement: On-Site, Hybrid Option May Be Considered After 90 Days
FLSA Classification: Exempt
Reports To: Chief Financial Officer

Position Overview

Talent Group is seeking an experienced Director of Revenue Cycle & Compliance (CalAIM) to lead healthcare revenue cycle operations, oversee billing compliance, and optimize reimbursement processes.

This leadership position is responsible for managing the complete revenue cycle for California Advancing and Innovating Medi-Cal (CalAIM) services, including Enhanced Care Management (ECM) and Community Supports. Responsibilities include claims processing, payer contract compliance, denial management, payment reconciliation, revenue forecasting, and operational improvements.

The ideal candidate brings extensive healthcare revenue cycle experience, strong knowledge of California Medi-Cal managed care requirements, and a proven ability to improve billing performance, implement internal controls, and lead cross-functional teams.

Key Responsibilities

Revenue Cycle Management

• Direct the complete CalAIM revenue cycle, from service documentation and claims submission through payment collection.

• Oversee billing accuracy, claims processing, payment posting, reconciliation, and collections.

• Monitor outstanding receivables, billing backlogs, denials, and reimbursement trends.

• Lead resolution of complex claims, payer disputes, and recurring billing issues.

• Identify and recover eligible unbilled or denied revenue within applicable deadlines.

• Establish key performance indicators and prepare weekly and monthly revenue cycle reports.

• Develop revenue forecasts and financial projections in collaboration with Finance leadership.

Payer Contracts & Regulatory Compliance

• Interpret and apply CalAIM, DHCS, and managed care plan billing requirements.

• Maintain accurate records of contracted services, billing codes, reimbursement rates, authorization requirements, and service limitations.

• Ensure compliance with payer agreements, HIPAA, and applicable state and federal billing regulations.

• Serve as a primary contact for health plans regarding billing, claims, and reimbursement issues.

• Identify compliance risks and recommend corrective actions.

Systems & Process Improvement

• Oversee billing workflows, payer portals, and electronic billing systems.

• Develop and implement standard operating procedures for revenue cycle functions.

• Establish internal controls, documentation standards, and reconciliation procedures.

• Support audits, compliance reviews, and system improvements.

• Identify opportunities to improve billing efficiency, data accuracy, and operational performance.

Financial Reporting & Reconciliation

• Partner with Finance to reconcile services delivered, claims submitted, payments received, and outstanding receivables.

• Analyze revenue variances, collection risks, and reimbursement trends.

• Provide accurate billing and collections data for financial reporting, budgeting, and cash flow planning.

• Present actionable recommendations to executive leadership.

Leadership & Team Development

• Supervise, train, and evaluate billing and claims personnel.

• Establish clear billing workflows and documentation requirements.

• Provide training to operational teams regarding authorizations, documentation, and billing accuracy.

• Collaborate with leadership to resolve documentation gaps and improve cross-functional processes.

• Support strategic planning related to revenue growth, payer relationships, and operational expansion.

Required Qualifications

• Bachelor's degree in Healthcare Administration, Business, Finance, Accounting, Health Information Management, or a related field, or equivalent experience.

• Minimum of 5 years of progressively responsible experience in healthcare revenue cycle management, Medi-Cal managed care billing, or healthcare reimbursement.

• Minimum of 2 years of supervisory, management, or senior technical leadership experience.

• Experience with California Medi-Cal managed care plans and DHCS reimbursement requirements.

• Strong knowledge of managed care contracting, claims processing, HCPCS codes, reimbursement methodologies, and denial management.

• Demonstrated ability to analyze revenue cycle data, develop procedures, and implement process improvements.

• Knowledge of healthcare compliance, HIPAA, and financial controls.

• Advanced Microsoft Excel and reporting skills.

• Excellent leadership, communication, and problem-solving abilities.

Preferred Qualifications

• Direct experience with CalAIM, Enhanced Care Management, or Community Supports billing.

• Experience with California Medi-Cal managed care plans, including Health Plan of San Joaquin/Mountain Valley Health Plan or Health Net.

• Experience in community health, behavioral health, or related healthcare service environments.

• Familiarity with SPRITE, electronic health records, or comparable billing platforms.

• Demonstrated success improving or restructuring revenue cycle operations.

• CRCR, CPB, or comparable professional certification.

First 90 Days

• Evaluate current revenue cycle operations and establish baseline performance metrics.

• Identify outstanding claims, denials, billing backlogs, and potential revenue recovery opportunities.

• Implement corrective actions to address recurring billing and reimbursement issues.

• Develop initial revenue cycle reports, recovery forecasts, and performance indicators.

• Begin standardizing billing procedures and payer contract requirements.

Key Performance Expectations

• Improve billing accuracy and regulatory compliance.

• Reduce preventable denials and outstanding billing backlogs.

• Increase eligible revenue billed and collected.

• Establish reliable revenue reporting and forecasting.

• Implement effective internal controls and standardized billing procedures.

• Maintain accurate, audit-ready revenue cycle documentation.

Equal Employment Opportunity

Talent Group is an Equal Opportunity Employer committed to providing employment opportunities to qualified applicants without regard to any legally protected characteristic.