CalAIM Billing Specialist

Calaim Billing Specialist I

Under direct supervision of CQI leadership and guidance of the CQI Billing and Records team, the CalAIM Billing Specialist I will be responsible for reviewing, submitting, and tracking claims for VOALA's Health Supportive Services division, consisting of Community Supports (CS) Housing (Housing Tenancy, Housing Deposit, Housing Navigation, and/or Recuperative Care) and Enhanced Care Management (ECM) programs, with the potential of additional CalAIM program inclusion. The role will monitor assigned CS and ECM program claims for errors and flag appropriate parties for billing corrections. The CalAIM Billing Specialist will track payments and ensure they are posted in the billing portal and accounting systems. This position will work closely with the CQI team, CalAIM Program Leadership, and accounting in order to ensure billing accuracy and timeliness. While they work within the CQI Department, this role is expected to work collaboratively with the CalAIM programs on an ongoing basis by providing support, mentorship and training. This role is responsible for maintaining member confidentiality and information security at all times.

Duties and Responsibilities

• The CalAIM Billing Specialist will ensure clean CS Housing and ECM claims are submitted through the billing portal and clearinghouse.
• Monitor billing errors that could involve issues around data entry for services in queue (i.e. units of services, time start and end time, etc.) and notify responsible parties to make timely corrections.
• Monitor and review denied claims and resubmit with corrected billing errors.
• Track all payments and ensure they are posted in the billing portal and all accounting systems.
• Support, coach, and train CalAIM program staff and team members in billing processes.
• Maintain and store all billing supportive documentation in designated Information System, as required by State guidelines.
• Assist in maintaining confidential records of members served.
• Maintain active accounts in all billing-related and Insurer portals.
• Conduct program site visits, as assigned by need.
• Develop, record, and distribute monthly reports, and/or general information, as needed.
• Support, as needed, with generating CalAIM services in billing portal and submit to designated Program Leadership.
• Assist leadership in reconciling data, as needed.
• Interact with accounting to ensure accuracy in billing and payments received.
• Remain current in updates made by Insurers, the state, and other regulatory bodies to ensure ongoing compliances and upholding best billing practices.
• Other duties as may be assigned by CQI Leadership.

Essential Duties

• An essential function of this position requires incumbents to report to the office.
• Submit clean claims in billing portals
• Monitor and support in correcting billing errors
• Resubmit denied claims with necessary corrections
• Track and document claims payments
• Train and coach CalAIM team members
• Other duties as required and is subject to change at any time.

Mandated Reporter

As service providers to the underprivileged and vulnerable in our community, all employees are considered Mandated Reporters, and must report any instance of physical or sexual abuse to proper authorities.

Qualifications

Requirements

• Must be able to pass a fingerprint clearance, background check, including criminal history, personal references, employment and education verifications
• Ability to perform under circumstances of possible emotional stress and conflicts dealing with difficult, uncooperative, and potentially aggressive clients as VOALA serves the neediest of the needy in our programs which may include clients with homelessness, mental-illness, substance abuse, recently released from incarceration and other challenges.

Education

• Associate Degree or equivalent combination of education and work experience (2 years of relevant experience / coursework)

Experience

• 1 year of experience with billing.
• 1 years of experience in Electronic Health Record database operations and/or billing submissions.

Preffered Qualifications

• Bachelor Degree
• Medi-Cal billing certificate
• Medi-Cal billing experience
• Experience with CalAIM