CalAIM Billing & Accounts Receivable Specialist

Internal Employees : If you currently work at IOA, please submit your application through the Internal Careers Page.

IOA is on the forefront of revolutionary healthcare models, reshaping the way people can age in place. Our innovative models transform lives, enhance communities, and save healthcare systems millions of dollars. Rather than focusing on archaic outdated design, we strive to consistently question the “status-quo” and create new and more innovative ways to help aging adults and adults with disabilities maintain their quality of life.

With over 23 programs, we offer multiple ways to aid seniors maintain their health, well-being, independence and participation in the community, fulfilling our mission.

The CalAIM Billing & Accounts Receivable (AR) Specialist supports the organization's revenue cycle operations within the Accounting department by ensuring accurate billing, timely claims processing, denial resolution, and effective accounts receivable management.

Reporting to the CalAIM Revenue Cycle Manager, this position is responsible for the day-to-day execution and follow-up of billing activities for CalAIM programs, including Enhanced Care Management (ECM) and Community Supports (CS). The Specialist works closely with Accounting, Program Operations, and Managed Care Plans (MCPs) to submit clean claims, resolve reimbursement issues, reconcile payments, and support timely cash collection.

Work Arrangement: This is a hybrid position requiring a minimum of three (3) days per week on-site, with remote work available on designated days, subject to departmental and organizational needs.

Essential Duties & Responsibilities

The following statements describe the primary responsibilities of this position and are not intended to be an exhaustive list of all duties.

• Prepare, review, and submit accurate and timely claims to Medi-Cal Managed Care Plans (MCPs), commercial payers, and other applicable funding sources.
• Review billing documentation for completeness and accuracy, including eligibility, authorizations, dates of service, and payer-specific requirements.
• Monitor claim status and follow up on rejected, denied, unpaid, and underpaid claims through final resolution.
• Investigate denials and reimbursement issues and prepare corrected claims, resubmissions, appeals, reconsiderations, and retroactive authorization requests as appropriate.
• Perform charge entry, payment posting, contractual adjustments, and reconciliation of Electronic Remittance Advices (ERAs), Explanation of Benefits (EOBs), and payer payments.
• Monitor accounts receivable aging by payer and program and perform timely follow-up on outstanding balances.
• Maintain billing trackers, denial logs, AR reports, payer issue logs, and supporting documentation.
• Identify recurring billing, authorization, documentation, or reimbursement issues and escalate significant or systemic concerns to the CalAIM Revenue Cycle Manager.
• Work with Program Operations, clinical teams, and other internal partners to obtain missing documentation and resolve billing discrepancies.
• Communicate with MCPs and other payers regarding claim status, payment discrepancies, authorizations, denials, and billing requirements.
• Maintain accurate documentation within applicable EMR/EHR, billing, and accounting systems.
• Support monthly billing and AR reconciliations, including reconciling claims submitted, payments received, outstanding balances, and adjustments.
• Provide billing and AR information to support monthly revenue estimates, revenue recognition, month-end close, and financial reporting.
• Stay current on Medi-Cal, CalAIM, MCP requirements, payer policies, and applicable billing regulations.
• Assist with payer onboarding, new billing requirements, system updates, workflow improvements, and internal or external audits.
• Perform other duties and special projects as assigned.

Required Qualifications

• Minimum of three (3) years of medical billing, healthcare claims, or accounts receivable follow-up experience in a healthcare setting.
• Demonstrated experience with Medi-Cal Managed Care, Medicaid, or commercial payer billing and claims processes.
• Experience preparing and submitting healthcare claims and following claims through final payment or resolution.
• Proven ability to investigate and resolve claim denials, prepare corrected claims and appeals, and address authorization-related billing issues.
• Experience with accounts receivable follow-up, payment posting, and reconciliation.
• Proficiency with EMR/EHR systems, billing software, payer portals, and Microsoft Excel, including sorting, filtering, and lookup functions.
• Strong analytical, organizational, problem-solving, and follow-up skills with excellent attention to detail.
• Ability to manage multiple payer deadlines and outstanding items independently while appropriately escalating complex issues.
• Excellent written and verbal communication skills and ability to collaborate effectively with Accounting, Program Operations, clinical teams, and external payers.

Preferred Qualifications & Education

• Associate's or bachelor's degree in Healthcare Administration, Business Administration, Accounting, Finance, or a related field.
• Direct experience with CalAIM programs, including Enhanced Care Management (ECM) and Community Supports (CS).
• Experience working with multiple Medi-Cal Managed Care Plans, payer portals, authorization management, and payer-specific billing requirements.
• Previous billing experience in home health, community-based services, behavioral health, care management, or value-based care programs.
• Working knowledge of healthcare documentation standards, payer reimbursement methodologies, revenue cycle processes, and billing compliance.
• Experience supporting billing reconciliations, month-end close, or accounting-related revenue cycle activities.

COMPENSATION:

Range: $80,000 to $90,000/annual

This amount is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any specific employee, which is always dependent on actual experience, education and other factors.

This range does not include any additional equity, benefits, or other non-monetary compensation which may be included.

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