Claims Specialist

Claims Specialist - Quality Assurance and Compliance (QAC)

For over 100 years, Vista Del Mar Child & Family Services (VDM) has taken great pride in providing exceptional programs and services for children and families throughout LA County. VDM envisions a community where all children and families are equipped and prepared to live productive, fulfilling lives. We serve the most vulnerable in Los Angeles, many of whom have faced multi-generational inequities. Vista Del Mar is guided by core values of empowerment, equity, and excellence.

At Vista Del Mar, our success is empowered by our staff, families, residents, and clients. We believe in the inclusion and liberation of marginalized communities, standing in unity for justice and recognizing long-standing systemic oppression. We acknowledge we are part of an unjust system and strongly advocate to change oppressive systems and the unconscious bias that affect staff, clients, and families in all communities. Vista is committed to developing a culture of healing, community care, and creating a sense of belonging. Our actions will be louder than our words.

Folks who are Black, Indigenous, people of color, LGBTQ+, of a marginalized gender, disabled, parents, are/have been system-impacted, are immigrants, and anyone who has experienced systemic oppression, and/or gender-based violence are encouraged to apply.

Vista Del Mar provides a trauma-responsive continuum of services to empower children, youth, and families in Southern California to lead fulfilling lives.

Position Overview

The Claims Specialist - Quality Assurance and Compliance (QAC) manages client information and funding eligibility of clients billed through the Los Angeles County Department of Mental Health (DMH) contract. Will be responsible for opening and updating client information in the Client Web Services (CWS) application, and for reviewing service claims submitted to the DMH's Integrated System Website, IBHIS.

Essential Job Duties (Other Duties May Be Assigned):

• Verifies funding eligibility status of DMH clients at admission and on a monthly basis and maintains financial information in client's TIER file and financial file. Disseminates any changes to programs and consults on any updates of funding eligibility.
• Daily, checks admissions and discharges in TIER, reviewing client's administrative face sheet to ensure that data is complete. Maintains an organized system of assigned program's clients to be able to track the status of needed information and ensure there is follow-up with programs as needed.
• As new clients are ready to be billed, reviews the IBHIS face sheet and financial information sent by programs to ensure that all information is accurate and complete in TIER. Submits all call information to Client Web Services (CWS);
• Daily, reviews non-final saved charges in TIER for any corrective action needed. Completes any updates or corrections required, and manually updates services charges and 'final save' so that claims can be batched;
• Daily, reviews Diagnosis and Financial Update Reports and Client Action Forms submitted for any client information that requires updating in CWS. If TIER data is complete, submits the call to update CWS;
• Monthly, runs Non-Final Saved Notes reports for programs assigned, reviews notes for action required., and disseminates to programs;
• Reviews Final Saved Charge reports before batching claims for electronic submission to DMH. Ensures that claims are submitted to the correct funding source, all claim data is accurate, and has been collected.
• Batches together all reviewed claims and submits to DMH's IBHIS website. Monitors the receipt of claims by IBHIS for any rejected claims, and follows necessary protocols to fix the rejected claims and resubmit them.

What You Bring To VDM?

• Background of education and/or experience in an office setting equivalent to a college education;
• Experience with insurance and submitting mental health claims; previous experience with Department of Mental Health contracts a plus;
• Must have good organizational skills and the ability to work cooperatively with others.
• Advanced computer skills.

Pay Range: $28 - $30.00 per hour

What Can We Offer You for All Your Hard Work?

• Full benefits offered (Medical, Dental, Vision)
• FSA/Dependent Care FSA and Supplemental benefits
• 403(b) – 3% Employer contribution based off annual salary
• 4 Mental Health Days
• Up to 12 Paid Holidays
• Up to 25% for Cell Phone Discounts with 3 Major Carriers (AT&T, Verizon, Sprint)

Vista Del Mar's Credentials:

Our nationally recognized clinical programs have been awarded a Gold Seal by the Joint Commission, the highest level of accreditation possible. In addition, our educational facilities are fully accredited through the Western Association of Schools and Colleges (WASC), and our graduate degree program is recognized worldwide for its high quality of instructions.

Equal Employment Statement

Vista Del Mar is committed to the full inclusion of all qualified individuals. Therefore, all qualified applicants will be considered for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Vista Del Mar will ensure that persons with disabilities are provided reasonable accommodations as part of this commitment.