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.

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 sitting, standing, and walking; talking or hearing, both in person and by telephone; using hands to operate, finger, handle, or feel office equipment; reaching with hands and arms; lifting up to 30 pounds; close vision and the ability to adjust focus; communicating effectively both verbally and in writing; reading, interpreting, and applying information and documents; exercising problem-solving and organizational skills; learning and applying new procedures and information; and managing multiple detailed tasks simultaneously.

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