Lead SUD Financial Operations Analyst

SUMMARY: The Lead SUD Financial Operations Analyst, Behavioral Health Financing, serves as the principal financial operations analyst supporting CalMHSA’s Drug Medi-Cal Organized Delivery System (DMC-ODS) Multi-County Model and is responsible for maintaining the financial integrity of provider reimbursement, county billing, reconciliation, reporting, and operational finance activities.

Reporting to the Director of Behavioral Health Financing, this position operates independently and owns complex financial workflows, including fiscal administration, provider payment operations, financial analysis, reconciliation activities, contract fiscal oversight, cost accounting practices, and financial compliance functions associated with CalMHSA’s role as Third-Party Administrator (TPA) for multiple county DMC-ODS programs. The position serves as the primary subject matter expert on county behavioral health substance use disorder financing and DMC-ODS financial operations and may provide technical leadership, project oversight, mentorship, or functional supervision of fiscal staff, consultants, and project resources as the Multi-County Model expands.

DUTIES AND RESPONSIBILITIES include but are not limited to:

· Oversee day-to-day DMC-ODS financial operations across multiple county jurisdictions.

· Review, validate, and process provider reimbursement requests and financial transactions.

· Manage county-specific invoicing and reconciliation processes.

· Monitor financial activity across multiple funding sources.

· Coordinate provider payment workflows and supporting documentation requirements.

· Coordinate financial aspects of provider contracting and payment methodologies.

· Track and monitor non-DMC expenditures, including room-and-board and other non-claimable services.

· Analyze service utilization, reimbursement trends, and expenditure patterns.

· Perform financial reconciliations between claims activity, provider invoices, county billings, and accounting records.

· Support development and maintenance of cost centers and project accounting structures.

· Maintain audit-ready financial records and supporting documentation.

· Evaluate denied services, payment variances, and reimbursement discrepancies.

· Develop executive and operational reports summarizing financial performance and operational trends.

· Assist with development of financial policies, procedures, contract terms, and workflow documentation.

· Support implementation and ongoing administration of DMC-ODS financial systems and reporting tools.

· Review provider financial records and monitoring documentation to ensure compliance with program requirements.

· Assist counties with financial reporting requirements associated with delegated DMC-ODS functions and support Multi-County Model participating counties claiming for Medi-Cal Administration and QA/UR using DHCS 5311 and DHCS 5312.

· Identify opportunities to improve operational efficiency, internal controls, and financial transparency.

· Collaborate with county fiscal staff, providers, auditors, consultants, and CalMHSA leadership.

· Provide technical guidance, financial subject matter expertise, and process leadership to support staff, consultants, or project participants.

· Serve as the primary financial operations resource for DMC-ODS provider reimbursement, county billing, and reconciliation functions.

· May assume responsibility for supervising fiscal analysts and coordinating the work of financial operations staff as the Multi-County Model grows.

· Perform other duties as assigned, demonstrating flexibility and commitment to organizational success.

BACKGROUND CHECK ELIGIBLE DUTIES

This position will have access to financial systems, claims data, provider payment information, county fiscal records, confidential health information, proprietary financial information, and other sensitive operational data necessary to perform delegated DMC-ODS administrative functions; ensure that access is used responsibly, maintaining the integrity and security of systems while preventing accidental or malicious misuse.

QUALIFICATIONS –

An acceptable equivalent combination of education, experience, and skill may be considered.

Education:

Bachelor’s degree in Accounting, Finance, Public Administration, Health Care Administration, Business Administration, Economics, or a related field required.

Experience:

· Five (5) or more years of progressively responsible experience in behavioral health finance, managed care operations, healthcare reimbursement, county government finance, Medicaid/Medi-Cal administration, or similar fields.

· Demonstrated experience with reimbursement systems, provider payments, financial analysis, financial monitoring, budgeting, accounting concepts, and operational finance.

· Experience supporting public-sector healthcare delivery systems preferred.

· Experience leading projects, coordinating cross-functional stakeholders, or providing technical guidance preferred.

· Experience overseeing financial reconciliations, cost accounting, and contract fiscal oversight for behavioral health or Medi-Cal programs; experience with DMC-ODS financing preferred.

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Job Specific Knowledge & Skills:

· Demonstrated knowledge of DMC-ODS and Medi-Cal financing, provider reimbursement, county billing, reconciliation, and delegated administrative functions.

· Demonstrated experience with cost accounting, contract fiscal oversight, financial monitoring, budgeting, and operational finance.

· Advanced proficiency in Microsoft Excel, including pivot tables, complex formulas, financial modeling, and reconciliation tools.

· Proficiency in Microsoft Word and relevant financial or data management systems, including EHR and claims or billing platforms.

· Familiarity with Power BI, SQL, or other reporting tools used to extract and analyze fiscal data preferred.

· Demonstrated ability to identify confidential and sensitive information and handle it with tact and discretion.

Communication Collaboration & Time Management Skills:

· Strong analytical, problem-solving, presentation, written, and verbal communication skills.

· Ability to communicate complex financial concepts clearly to county leadership, provider representatives, fiscal staff, and other diverse audiences.

· Ability to exercise independent judgment, conduct research, and ask appropriate probing questions to complete necessary tasks.

· Demonstrated ability to manage multiple priorities and concurrent projects and collaborate effectively with internal and external stakeholders.

· Comfortable using virtual collaboration tools, including Teams, Zoom, and SharePoint.

Personal Attributes:

· Detail-oriented and organized, with a strong commitment to accuracy, financial integrity, and best practices.

· Demonstrates initiative, independence, sound judgment, and resourcefulness in completing assignments.

· Adaptable and able to manage shifting priorities in a fast-paced, high-stakes environment.

· Comfortable working in a remote environment and maintaining accountability to leadership.

· Willing to travel as needed to support county partners and attend meetings or trainings.

PHYSICAL DEMANDS - 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 frequently required to sit and stand; use phone and headset; use hands, arms, and fingers to type; answer phones; write; use a calculator; lift and carry materials weighing up to 10 pounds; demonstrate clear vision to read printed materials and a computer screen; use hearing and speech to communicate in person and over the telephone; and drive a motor vehicle on public roads and highways.

SENSORY DEMANDS - The incumbent must spend long hours in intense concentration. The incumbent must also spend long hours on the computer entering information, which requires attention to detail and high levels of accuracy.

MENTAL DEMANDS - There are a number of deadlines associated with this position, which may cause significant pressure. The incumbent must also deal with a wide variety of people on various issues and manage multiple concurrent projects and shifting priorities in a fast-paced, high-stakes environment.

REGULAR WORK SCHEDULE – Varies depending on business needs; however, company normal business hours are 8:00am to 5:00pm, Monday – Friday