County Claims & Compliance Specialist (Hybrid Option)

Job Description and Duties

Why Join DHCS?

The Department of Health Care Services (DHCS) is the backbone of California’s health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities. This is an exciting opportunity to join our diverse team in the following role. If you are interested in joining our team, apply today!

About this Role:

Under direction of the MedCCC Supervisor I in the SDMC Section, the Health Program Specialist I (HPSI) will serve as a skilled technical program consultant, providing policy and consultative advice on complex and sensitive policy matters within the Branch. The HPSI will function as a Branch expert advisor and specialist for Medi-Cal behavioral health fiscal policies and the respective implementation of claiming policies in the Short Doyle Medi-Cal adjudication and payment systems. The Health Program Specialist I (HPSI) is a member of the County Claims Customer Services (MedCCC) Unit. The MedCCC Unit provides technical assistance and customer service to 58 county mental health plans and behavioral health departments related to fiscal and claiming policies for Medi-Cal’s behavioral health programs. The HPSI independently performs a variety of complex analytical and research activities related to behavioral health care services delivered to Medi-Cal beneficiaries in California. The incumbent is required to demonstrate initiative, good judgment, and the ability to handle confidential/sensitive information when performing assigned tasks. The incumbent is subject matter expert in ensuring adherence with all federal and state Medicaid claim payment laws, regulations, and directives.

The incumbent is also responsible for maintaining ongoing technical support for complete, timely, and accurate claim inquiries. The incumbent performs complex administrative responsibilities including researching, and analyzing behavioral health claim payment legislation, policies, and procedures and making recommendations on optimal solutions, trouble-shooting behavioral health claim problems; editing documentation for quality control; interpreting and applying federal regulations and directives; creating, implementing, or revising state regulations, policies and procedures.

Have questions and/or need assistance? Contact View email address on us.fitly.work , we are here to help walk you through the state hiring process!

You will find additional information about the job in the .

Working Conditions

Please see the Telework and Salary Information section below for telework, reporting location, and temporary statewide salary reduction details.

Special Requirements

Simple Application Steps:

If you are interested in this position, complete the following simple steps:

Simple Application Steps:

If you are interested in this position, complete the following simple steps:

1. Review the education and experience minimum qualifications (MQ’s) of the Health Program Specialist I . See the Minimum Requirements section below.

2. Complete the statement of qualifications and the state application by clicking “Apply Now” above. See below for detailed application instructions.

3.Submit your application package with all required documents, which include the statement of qualifications - see the "Required Application Package Documents" section below.

4. Once you have applied, take the Health Program Specialist I CalCareers exam.

Statement of Qualifications Requirement Section:

Applicants must include a Statement of Qualifications (SOQ) for this recruitment. The SOQ is a narrative discussion, not a cover letter, prepared by the applicant describing how their skills, knowledge, abilities, education, training, and experience, qualify them for the position. The SOQ serves as documentation of the applicant’s ability to present information clearly and provide DHCS additional information about their experience and qualifications concisely in writing. The DHCS may not consider applicants who fail to provide an SOQ with their application. Resumes do not take the place of the SOQ.

A Statement of Qualifications (SOQ) is required to apply. The SOQ must be typed, no longer than two pages in Arial font size 12. Please include your First and Last name, along with the Job Control Number, in the upper left hand corner. Applicants who submit an incomplete SOQ will not be considered.

1) Explain how your education, experience and/or training make you a qualified candidate for this position.

2) What is your process in researching and resolving complex health care related issues?

3) In your own words, how would you define good customer service?

Candidates who do not complete and submit an SOQ may not be considered for this position.

Desirable Qualifications

In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate:

-Strong analytical skills with the ability to problem-solve and use critical and creative thinking skills.

-Ability to communicate effectively orally and in writing with internal and external stakeholders.

-Knowledge of research, survey, and analytical methods and techniques

-Ability to prepare and present technical reports and make recommendations

-Ability to manage and prioritize multiple projects

-Ability to work independently and in a team environment

-Experience using Microsoft Excel or similar data management software.

-Experience analyzing data and making recommendations for process improvements to a system or project.

Benefits

DHCS is dedicated to creating an innovative workplace for its team members that is inclusive, diverse, and interactive! Here are a few of the ways we stay engaged with our team:

· Continuous and ongoing training

· Diversity, Equity, and Inclusion program activities

· Employee Assistance Program (EAP)

Additionally, as a team member of the State of California, you may be eligible for many benefits, such as:

· Medical, including health, dental, and vision insurance.

· Paid Holidays and vacation/leave

· Defined retirement program

· Savings Plus Program (401(k), 457)

· Medical/Dependent Care Reimbursement Accounts

Full benefits information can be found on CalHR's 

provides more information about our commitment to serving Californians and organizational excellence.

We need your help! Please let us know how you heard about our position by taking this brief optional survey: . This survey is not required to be considered for this position.

Telework and Salary Information

This position is currently eligible for telework. The amount of telework is at the discretion of the Department and is subject to change consistent with DHCS’ Telework Program and Government Code sections 14200 – 14203. Telework is available to California residents, and proof of residency may be required. 

Business travel may be required, and reimbursement considers an employee’s designated office and residence subject to regulations and bargaining unit contract provisions. All commute expenses to the reporting location will be the responsibility of the selected candidate. 

The DHCS office location for this position is 1501 Capitol Avenue, Sacramento CA, 95814.

Salary: Effective July 1, 2025, the California Department of Human Resources (CalHR) implemented the temporary Personal Leave Program 2025 (PLP 2025). PLP 2025 directs that each employee receive a temporary reduction in pay in exchange for PLP 2025 leave credits. The temporary salary reduction percentage and the number of PLP 2025 leave credits are based on the position’s associated bargaining unit. The salary range(s) included in this job advertisement do not include the temporary salary reduction. Please reach out to the hiring unit contact listed on this job advertisement for details.

Required Application Package Documents

The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:

• Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
• Resume is required and must be included.
• Statement of Qualifications -

  Refer to the Statement of Qualifications Requirement Section for instructions.