County and CalAIM Billing Specialist

California, in LA / San Jose / Santa Cruz regions, primarily remote, but with an expectation of coming in 1 day a week to HQ or facilities. Resumes from out of state will not be considered. Pay $65K - $90K depending on level of experience Company Description The company has a number of healthcare facilities, including RCFEs, ARFs, and recuperative cares, across the California. The work is centered on billing the MCPs for CalAIM community supports (Recuperative Care, Housing Navigation, Tenancy, Deposits, etc.), ECM (Enhanced Care Management), and also on billing counties / the VA for adults residing in RCFEs/ARFs with behavioral health issues. Position Overview Responsible for the accurate and timely preparation, submission, auditing, monitoring, and resolution of billing transactions to ensure appropriate reimbursement and financial integrity. The Billing Specialist manages the billing process from initial claim creation through final payment resolution, including account auditing, payment posting, denial management, accounts receivable follow-up, and reconciliation activities. Essential Functions Prepares, reviews, and submits claims and invoices accurately and timely. Audits patient accounts, charges, authorizations, supporting documentation, and billing records to ensure accuracy and completeness prior to submission. Monitors billing work queues and accounts receivable aging reports. Performs follow-up on outstanding claims, unpaid balances, denials, underpayments, and rejected submissions. Researches and resolves billing discrepancies, claim edits, payment variances, and reimbursement issues. Submits corrected claims, appeals, reconsiderations, and supporting documentation. Posts payments, adjustments, contractual allowances, and credits while ensuring account accuracy. Collaborates with clinical, authorization, intake, coding, and operational teams. Analyzes aging reports and prioritizes accounts requiring immediate attention. Maintains knowledge of payer requirements, billing regulations, reimbursement methodologies, and HIPAA standards. Essential Qualifications High school diploma or equivalent required; Medical Billing certification preferred. Minimum 3 years of healthcare billing, accounts receivable, medical collections, or revenue cycle experience. Demonstrated experience managing the complete billing cycle from claim submission through final account resolution. Experience auditing accounts, billing records, charges, payments, adjustments, and supporting documentation. Knowledge of ICD-10, CPT, HCPCS, Medicare, Medicaid, and commercial payers. Strong analytical, organizational, and communication skills. Attention to Detail Maintains a high level of accuracy when reviewing claims, patient accounts, payments, adjustments, authorizations, and supporting documentation to minimize billing errors and reimbursement delays. Critical Thinking Analyzes account activity, identifies root causes of billing discrepancies, denial trends, and payment variances, and develops effective solutions to resolve issues. Accountability & Ownership Takes responsibility for assigned accounts and follows issues through to completion while ensuring timely and accurate resolution. Communication Skills Communicates professionally and effectively with patients, payers, providers, vendors, and internal team members, both verbally and in writing. Problem-Solving Ability Researches, investigates, and resolves complex billing, reimbursement, and account issues while maintaining compliance with organizational and payer requirements. Time Management Effectively prioritizes workload, manages multiple responsibilities, and consistently meets productivity, quality, and reporting deadlines. Organization Skills Maintains well-organized account documentation, billing records, correspondence, and follow-up activities to support accurate and efficient workflow management. Persistence & Follow-Through Demonstrates diligence and determination when following up on outstanding claims, denials, underpayments, and unpaid balances until resolution is achieved. Works effectively with billing, coding, authorization, clinical, intake, and operational teams to resolve issues and support revenue cycle objectives. Integrity & Confidentiality Handles sensitive patient, financial, and company information with discretion while adhering to HIPAA requirements and organizational standards. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the position. Most work will be completed in a well- lit office environment, but all areas of the office and potential travel/work in client locations/facilities/communities may also be required. Primarily sedentary office work with ability to stand, sit, walk throughout the workday Use of various technology/computers (typing, screens), sitting at a desk for long periods Bend, reach, stoop, kneel, crouch, reach, push and pull up to 25 lbs Ability to climb, crawl and balance as needed for setting up office / work area(s) Use of fingers/hands to type, handle, pick up and feel objects, using tools as needed Must see and hear with, or without, prosthetics that enable these sense to function adequately to ensure all requirements for the position are met Ability to travel via plane, car, or use public transportation as needed for work Ability to cope with the mental and/or emotional stress of the position #J-18808-Ljbffr Moses Staff Agency