Medical Billing Specialist

Job Description

Job Description

Job Summary

We are seeking a detail-oriented and customer-focused Medical Billing Specialist to join our mental healthcare team. In this role, you will be responsible for managing the billing process, ensuring accurate claims submission, and maintaining compliance with health insurance policies. The ideal candidate will possess strong knowledge of health insurance procedures, experience with electronic health record (EHR) systems, and a commitment to quality assurance. This position offers an opportunity to contribute to efficient revenue cycle management while providing excellent service to clients and insurance providers.

Duties

• Provide assistance to program staff to update outcome data and creating program reports
• Assist in the management of program Information System in accordance to DMH protocol.
• Review and analyze denied claims from LACDMH and other payers to identify root causes and resolution strategies.
• Track denied claims for denied codes and troubleshoot any billing issues with denied claims.
• Monitor insurance status of clients and send monthly updates to DMH.
• Monitor monthly change of provider status and send updates to DMH.
• Perform other tasks and responsibilities as assigned by the Program Director and/or Program Coordinator.
• Provide linkage with other health facilities (pharmacy, lab, medical offices, partners).
• Provide administrative support for program staff and managers as needed.
• Provide support for providers/doctors: scheduling, troubleshoot systems, QA related, and entering new clients into Quest lab systems.
• Provide support for QA team: compiling new blank charts, conducting an initial 25-Day QA Review and follow-up for new charts, uploading charts into EMR.
• Updating NAPPA of yearly Cultural Competency Trainings.
• Regularly update NAPPA on behalf of clinicians to maintain current and accurate information.
• Tracking yearly Cultural Competency Trainings for staff and maintaining training database.
• Creating accounts and setting up new staff in Exym and NAPPA.
• Updating staff professional licenses in Exym.
• Resolving claims with problems preventing invoicing and resolving voided claims.
• Resolving activities needing attention in Exym.

Minimum Qualifications - Knowledge, Skills and Abilities Required

High School Diploma.

Bachelor’s degree preferred.

Medical Billing Certification

One year of direct service experience in a hospital or mental health setting which has an interdisciplinary team approach.

Knowledge: Basic Computer software programs (Experience on Microsoft Word and

Excel, Internet; Medi-cal, Medicare, private insurance, etc.)

Skills: Good writing and oral (communication) skills are necessary; Strong interpersonal and social skills; Time management skills necessary; Strong analytical skills, problem solving abilities and sharp attention to detail

Abilities: Ability to develop and maintain effective working relations with program and with community representatives and contractors; Ability to work both independently and as a member of a team.

\nCompany Description

Special Service for Groups, Inc. – better known as SSG – is a non-profit health and human service organization dedicated to building and sustaining community-based programs that address the needs of vulnerable communities. Special Service for Groups (SSG) is a non-profit organization dedicated to provide community-based solutions to the social and economic issues facing those in greatest need. SSG has evolved into a model organization designed to provide services for diverse groups with maximum efficiency and impact. This is achieved by developing and managing programs which serve our many communities by encouraging their involvement and self-sufficiency. SSG believes that the needs of groups and individuals cross traditional ethnic, racial and other cultural boundaries. SSG serves as a bridge between people with common needs to identify ways to pool resources for the greater good of all.

Company Description

Special Service for Groups, Inc. – better known as SSG – is a non-profit health and human service organization dedicated to building and sustaining community-based programs that address the needs of vulnerable communities. Special Service for Groups (SSG) is a non-profit organization dedicated to provide community-based solutions to the social and economic issues facing those in greatest need. SSG has evolved into a model organization designed to provide services for diverse groups with maximum efficiency and impact. This is achieved by developing and managing programs which serve our many communities by encouraging their involvement and self-sufficiency. SSG believes that the needs of groups and individuals cross traditional ethnic, racial and other cultural boundaries. SSG serves as a bridge between people with common needs to identify ways to pool resources for the greater good of all.