Billing and Claims Specialist

Job Description

Job Description

Employment Type: 12 months

Type: Full-Time

FLSA Status: Non-Exempt

Compensation: Min. $20.91/hr. - Max. $26.77/hr. in 6 steps

Application Deadline: Open Until Filled

MISSION STATEMENT:

Join Kings Community Action Organization (KCAO) and make a difference in Kings County, CA as a H&E Billing and Claims Specialist. KCAO envisions a future where all people in Kings County are able to live with dignity, have access to available resources and have the opportunity, motivation and ability to live economically productive and satisfying lives.

Our Mission: Working as a team, KCAO will seek and provide programs that develop self-sufficiency in individuals, families, and communities within Kings County.

Our Vision: Kings County residents and communities will achieve self-sufficiency through the high quality and client-focused programs of KCAO.

We are a private nonprofit helping people and changing lives in Kings County since 1965. Do you see yourself as part of our team of passionate, committed, and caring people?

JOB SUMMARY:

The H&E Billing and Claims Specialist is responsible for supporting the H&E Department in the execution and timely delivery of information, payment processing, data collection, data entry and reporting. This role ensures compliance with payer requirements, resolves claim denials, and works closely with managed care plans and funders.

DUTIES AND RESPONSIBILITIES:

• Prepare, review, and submit claims accurately and in a timely manner.
• Monitor claim status and follow up on unpaid, denied, or underpaid claims.
• Analyze and resolve claim denials, rejections, and payment discrepancies.
• Prepare and route check requests and purchase requisitions to ensure prompt payment of financial obligations.
• Complete monthly data and invoice reports in accordance with program requirements.
• Reconcile invoices to statements and purchase orders, ensuring accuracy and completeness.
• Ensure all documents are properly completed, signed, and distributed in accordance with established procedures.
• Allocate payments in accordance with established policies and procedures.
• Communicate effectively with vendors, staff, and clients regarding billing and payment matters.
• Maintain accurate and organized billing files and documentation.
• Support program operations by ensuring compliance with programmatic and reporting requirements.
• Maintain compliance with HIPAA, payer guidelines, and organizational policies.
• Stay current on billing regulations, payer policies, and reimbursement changes.
• Attend and participate in department, agency, and community meetings, as required.
• Work collaboratively with internal staff and external partners to support program and financial operations.
• Support departmental operations by assisting with tracking check requests, invoices, and program-related documentation, as needed.
• Assist with data entry, file maintenance, and preparation of reports to support program and compliance requirements.
• Assist with coordinating meetings, trainings, outreach activities, and related logistics to support program operations.
• Provide administrative support to the Home & Energy program, including scheduling, document preparation, and coordination efforts, as needed.
• Perform general clerical support functions, such as answering phones, scanning documents, and maintaining organized records, as needed to support departmental workflow.
• Perform other duties as assigned.

EDUCATION/EXPERIENCE REQUIREMENTS:

Associate's degree in business administration or related field from an accredited institution  AND

• Two years of progressively responsible clerical or administrative experience.

OR

• High school diploma (or equivalent)  AND
• Five years of progressively responsible clerical or administrative experience.

PREFERENCES:

• Familiarity with California communities and Medi-Cal populations
• Experience working in a community-based organization
• Experience in Medi-Cal billing

OTHER REQUIREMENTS:  

• Attend local and out of area meetings and conferences as required per the funding source(s) or as directed.
• Meet and maintain KCAO hiring requirements which include:
• Criminal Record Clearance including California DOJ, FBI, Child Abuse Centralized Index (CACI), National Sex Offender Public Website (NSOPW), and the California Sex and Arson Registry (CSAR) (Megan's Law).  Health examination with tuberculin clearance.
• Ability to be contacted outside of regularly scheduled work hours in case of emergency.

KCAO is an Equal Opportunity Employer and a Drug Free Workplace

KCAO participates in the E-Verify program that electronically confirms an employee's authorization to work in the United States that complies with the I-9 form.