CalAIM Billing Specialist

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Role & Responsibilities:

Accurately prepare and submit claims for services rendered to Medi-Cal CalAIM, ensuring compliance with program guidelines and regulations

Identify health plan eligibility when coverage is not populated on claim

•Add Authorizations for CalAIM services on to claims

•Ensure claim data contains all elements required for subm

•Review and verify the completeness of claims documentation, resolving any discrepancies or issues promptly

•Collaborate with internal teams to gather necessary information for billing purposes

•Monitor reimbursement activities, identifying and addressing any billing errors or discrepancies

•Stay updated on changes to the Medi-Cal CalAIM program regulations, policies, and billing procedures

•Ensure strict adherence to program requirements and maintain compliance with all relevant guidelines

•Maintain accurate and organized records of billing transactions, claims submissions, and related documentation

•Prepare reports and summaries as required for internal and external audits

•Communicate effectively with internal stakeholders, including care managers and administrative staff, to address billing-related inquiries and resolve issues

•Collaborate with external entities, including Medi-Cal representatives and regulatory bodies, to facilitate smooth billing processes

Qualifications:

The ideal candidate will have experience navigating the complexities of Medi-Cal reimbursement and ensuring compliance with program regulations

Bachelor's degree in Healthcare Management, Business Administration, or a related field

Minimum of 3 years of experience in billing and claims processing, with a focus on Medi-Cal programs

Job Type: Full-time

Pay: $20.59 - $27.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Work setting:

• Office

Ability to Relocate:

• Stockton, CA 95202: Relocate before starting work (Required)

Work Location: In person