Billing Specialist (51389)

Billing Specialist

Salary Range $24.00 - $24.00 Hourly Position Type Full Time Education Level High School Category Nonprofit - Social Services

Description

POSITION SUMMARY: The CalAIM Billing Specialist is responsible for ensuring accurate and timely billing for CalAIM justice-involved pre-release services. This position supports program operations by verifying documentation, preparing billing submissions, monitoring reimbursement, and ensuring compliance with Medi-Cal and Managed Care Plan billing requirements. Essential Job Functions are below.

ESSENTIAL JOB FUNCTIONS:

• Review program documentation to ensure services meet CalAIM, Medi-Cal, and Managed Care Plan billing requirements.
• Prepare and submit billing for CalAIM services, including Enhanced Care Management and applicable pre-release services.
• Verify eligibility, enrollment, and service authorization requirements prior to billing submission.
• Coordinate with program staff to ensure documentation supports billable services and meets required standards.
• Monitor billing activity, track claims submissions, and follow up on denied or pending claims.
• Work with Managed Care Plans to resolve billing discrepancies and reimbursement issues.
• Maintain accurate billing records and ensure timely submission of claims.
• Generate billing reports and provide updates to program leadership regarding billing status and reimbursement trends.
• Support compliance with regulatory and contractual billing requirements.
• Assist in the development and implementation of billing procedures related to CalAIM services.
• Embrace and embody the mission, vision, guiding principles, clinical vision, and goals of WestCare Foundation.
• Perform other duties as assigned.

Qualifications

ESSENTIAL QUALIFICATIONS: To perform this job successfully, an individual must be able to perform the duties and responsibilities satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Experience and Competencies: Strong attention to detail, organizational skills, and ability to manage multiple deadlines. Valid driver's license and ability to obtain and maintain WestCare's vehicle insurance is required. Ability to obtain and maintain successful background clearance. During your tenure with WestCare there may be new requirements, including, but not limited to vaccinations that are issued by local, State, Federal, and/or Funders that WestCare may have to comply with. Should this occur Human Resources or appropriate personnel will inform you. CPR Certification, First Aid Certification, and an annual Tuberculosis test.

EDUCATION and/or EXPERIENCE: Experience with Medi-Cal, CalAIM, Enhanced Care Management, or healthcare billing preferred. Knowledge of healthcare documentation and billing practices. High school diploma or equivalent required; associate or bachelor's degree preferred.

LICENSURE/CERTIFICATION: Not applicable for this position.

WORKING CONDITIONS: Work is performed in a combination of correctional facilities, office environments, and community settings. Regular interaction with justice-involved individuals and multidisciplinary care teams. Local travel is required to correctional facilities, partner agencies, and community providers.