BILLING SPECIALIST - CCSEP

Billing Specialist

Under the supervision of the Billing Specialist II, the Billing Specialist performs a range of administrative, billing support, and reimbursement-related duties in support of Medi-Cal reimbursable behavioral health services. This position is responsible for the timely and accurate entry, review, and maintenance of client eligibility, billing, and service data within the Electronic Health Record (EHR). Duties include generating and reviewing routine billing, service, and error reports to identify documentation and charge discrepancies; coordinating with providers, supervisors, and program staff to ensure timely resolution of errors; verifying insurance eligibility; preparing and submitting billing-related documentation; and providing general administrative and customer service support to program operations.

Examples of essential duties include completing insurance eligibility verification for Medi-Cal, Medicare, and Other Health Coverage (OHC) in accordance with program and billing requirements; tracking, documenting, and following up on corrections to ensure accurate and complete service records prior to billing submission; providing administrative and clerical support to program operations, including preparing correspondence, scheduling meetings, maintaining calendars, and responding to telephone inquiries; assisting with electronic health record (EHR) and information system functions including data entry, corrections, report generation, scheduling, and billing support activities; collecting, organizing, and preparing monthly program documentation and reports to support billing and reimbursement processes; developing, organizing, and maintaining billing, filing, and recordkeeping systems to ensure accuracy and accessibility of records; creating, updating, and maintaining databases and tracking systems related to program services, billing, and reporting requirements; assisting in preparing monthly program, billing, productivity, and mileage reimbursement reports; maintaining confidentiality of protected health information in compliance with HIPAA, County, and program standards; and completing all other duties as assigned.

Desired minimum qualifications include knowledge of medical and behavioral health billing principles, including Medi-Cal reimbursement requirements and County or County-contracted billing systems; experience with insurance eligibility verification and claims processes, including Medicare and Other Health Coverage (OHC); ability to generate, review, and analyze EHR billing and service data to identify and resolve errors; knowledge of documentation standards required to support Medi-Cal reimbursable services; familiarity with HIPAA regulations, confidentiality requirements, and compliance standards; experience working with culturally diverse populations and understanding of behavioral health-related social, economic, and systemic factors; ability to apply sound judgment within established policies and procedures; strong written and verbal communication skills; proficiency with computers, EHR systems, and standard office software applications; ability to operate standard office equipment and perform administrative support functions; and completion of all other duties as assigned by Supervisor and Program Director.

Language skills include ability to effectively present information and respond to questions primarily in English from managers, providers, County billing staff, clients, and the general public; demonstrated skills in clear, professional written and oral communication related to billing, documentation, and data correction issues.

Mathematical skills include ability to add, subtract, multiply, and divide using whole numbers, common fractions, and decimals; ability to review units, dates of service, and billing data for accuracy and consistency.

Reasoning ability includes ability to define problems, collect and review EHR and billing data, establish facts, and draw valid conclusions; ability to interpret technical billing instructions, compliance requirements, and documentation standards and apply them to service correction and billing support activities.

Experience and training include a high school diploma or G.E.D. equivalent, and at least three (3) years of clerical, billing, or administrative experience in a healthcare, behavioral health, or social services setting with supervisory experience; Bachelor's degree preferred and/or experience supporting Medi?Cal billing processes in a County or County?contracted program preferred; billing and financial training and/or certification highly desirable; experience and training in SmartCare or similar behavioral health EHR systems highly desirable; or an equivalent combination of training and experience.

Licenses, certificates, and special requirements include a valid driver's license with current California automobile insurance; a valid cardiopulmonary resuscitation (CPR) certification; a valid tuberculosis (TB) test upon hire and updated every two to four (4) years depending on the contract requirements.

Physical and mental demands include being regularly required to sit, stand, and walk; talk or hear, both in person and by telephone; use hands to operate, finger, handle or feel office equipment; reach with hands and arms; and lift up to 30 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Employees are regularly required to communicate effectively both verbally and in writing; read, interpret, and apply information and documents; exercise problem-solving and organizational skills; learn and apply new procedures and information; and manage multiple detailed tasks simultaneously. The position requires the ability to work in a fast-paced environment with frequent interruptions, changing priorities, and deadlines while maintaining professionalism, patience, and a supportive approach when interacting with management, staff, vendors, program participants, including individuals with Serious Mental Illness (SMI), and members of the public who may at times be anxious, upset, or impatient.

The work environment includes typical office conditions, and the noise level is usually quiet.