Billing and TAR Specialist

Organization:

Founded in 2003, AMI Housing is a California-based nonprofit organization whose mission is to enhance the lives of people with mental illness through housing, employment, and supportive services. To house and support the most vulnerable residents of the Sierra region.

Summary of primary job functions:

The CalAIM Billing and TAR Specialist will be responsible for processing billing for Community Supports services provided to clients, managing the treatment authorization requests and referral process, and ensuring compliance with relevant Medi-Cal policies. This role requires strong attention to detail, excellent communication skills, and the ability to navigate complex health systems to ensure timely processing of billing and authorization requests. The ideal candidate will have strong knowledge of CalAIM billing processes, experience in the homeless services sector, and a deep commitment to improving the lives of vulnerable populations.

Examples of essential duties may include, but are not limited to, the following:

• Prepare, submit, and follow up on CalAIM Medi-Cal claims for covered services.
• Review and ensure all claims are accurate and in compliance with state and federal regulations, specifically the CalAIM initiative.
• Collaborate with the finance team to track reimbursements, resolve discrepancies, and ensure proper coding and documentation for claims.
• Complete and submit Treatment Authorization Requests (TARs) for services provided to individuals under the CalAIM initiative.
• Ensure TAR submissions are timely, accurate, and contain all required supporting documentation.
• Track and follow up on TAR approvals and denials, addressing any issues or concerns promptly.
• Maintain accurate records of all billing, claims, and TAR activities in accordance with organizational and regulatory standards.
• Provide periodic reports to management regarding billing and TAR status, trends, and any challenges faced.
• Work closely with the case managers and other staff to ensure all necessary documentation is submitted for billing and authorization purposes.
• Supports staff with the completion and submission of required security deposit and transitional rent documentation, ensuring forms are accurate, complete, and submitted in a timely manner
• Work closely with AMIH teams to ensure seamless delivery of services and effective coordination of client needs.
• Provide training and support to internal teams on CalAIM billing procedures and Treatment Authorization Request protocols as needed.
• Serve as the point of contact for any billing related inquiries from both internal and external stakeholders.
• Participate in the planning, execution, and ongoing evaluation of CalAIM initiatives within the organization.
• Work closely with all AMIH teams to ensure the seamless delivery of services.
• Assist with the preparation of reports for internal leadership, funders, and government agencies ensuring that data is presented clearly and effectively.
• Identify opportunities for continuous improvement based on data-driven insights.
• Maintain current knowledge of program regulations and procedures necessary for multi-program caseload administration.
• Model personal responsibility, advocacy, resiliency/recovery, integrity, and cultural humility for department.

Skills:

• Ability to initiate difficult conversations, confront issues directly, implement effective solutions, and consistently reinforce standards and expectations to prevent and deescalate workplace problems.
• Must multitask with attention to detail while working in a fast-paced and sometimes chaotic environment.
• Ability to plan, organize, and prioritize work.
• Communicate clearly and concisely through telephone, written, and electronic methods. (STRONG phone etiquette and effective communication)
• Must have critical and analytical skills.
• Type/Enter data at a speed necessary to meet job duties.

Ability to:

• Continuously sit at a desk and/or stand at the counter for extended periods; use the keyboard to communicate through written means; run errands; lift lightweight.
• Continuously sit at a desk for long periods; intermittently walk, stand, bend, climb, squat, twist, and reach while retrieving or returning files or making field visits. Intermittently twist to get equipment surrounding desk; perform simple grasping and fine manipulation; see with correctable acuity sufficient to read characters on a computer screen; hear and speak with correctable acuity enough to communicate with others.
• Make rapid and accurate arithmetic calculations, including addition, subtraction, multiplication, and division.
• Understand the organization and operations of the AMIH and community partners as necessary to assume assigned responsibilities.
• Compile and maintain extensive records and files.
• Operate a variety of office machines/computers and software systems.

• High school diploma or equivalent required.
  • Associate’s or Bachelor’s degree in social services, human services, or a related field preferred.
• Bilingual fluency (English/Spanish) is strongly preferred.
• Complete and pass pre-employment background checks (fingerprints, TB Clearance, drug and alcohol testing, and criminal background checks).

Work experience may include :

• 3 years experience in Community Supports, Enhanced Care Management, CalAIM, or Medi-Cal billing
• 2 years experience gathering and entering data into information systems, such as Coordinated Entry and Homeless Information Management System (HMIS).
• Demonstrated work experience indicating knowledge and proficiency in Treatment Authorization Requests processes.
• Demonstrated work experience working with underserved populations, preferably the homeless community.

Licenses and Certification :

• Possess a valid driver's license with a clean driving record as required by the position.
• Proof of adequate vehicle insurance and medical clearance is required.

Computer Proficiency :

• Strong computer proficiency (i.e., Outlook, SharePoint, Microsoft Teams, Microsoft Word, Excel, PowerPoint, Zoom, Welligent, App Folio, Adobe, DocuSign, Google Docs, Internet, and Calendar) to complete daily duties within the expected timeframes with little to no supervision.

Personal Characteristics :

• Be welcoming and supportive. Displays a strong desire to advance the agency’s mission and help people with mental illness improve their lives by becoming independent, successful community members.
• Work in a client-centered, strength-based, and harm-reduction manner.