DEPARTMENT: Programs

REPORTS TO: Contracts & Business Development Manager

LOCATION: Sebastopol, CA; Remote

FLSA STATUS: Regular, Part time, Non-exempt

HOURS: 20/week

Position Summary

The Billing Specialist is responsible for the timely submission and accurate reconciliation of electronic claims submitted to any/all contracted healthcare plans such as Partnership HealthPlan or Kaiser Permanente. This position will monitor the delivery of service units authorized by the healthcare plan, ensure monthly claims are submitted electronically, reconcile insurance payments against charges, and troubleshoot any denials or other aging claims to maximize reimbursement.

Essential Functions and Responsibilities

• Monitors the delivery of service units approved on Treatment Authorization Requests (TAR) and ensures all billable units are submitted electronically.
• Enters accurate client and service unit claims data into EZClaim with meticulous detail to minimize potential for denied or rejected claims.
• Reconciles payments against charges in EZClaim and accurately reports aging claims to the Contracts & Business Development Manager.
• Troubleshoots claim denials or rejections with the healthcare plan to maximize reimbursement.
• Tracks service units completed and billed in Salesforce and other platforms as necessary, e.g., the Partnership Portal.
• Supports client care efforts to collect medical data that supports TARs and/or claims billing.
• Other duties as required and requested.

Qualifications

• Minimum 2 years’ experience with Medi-Cal billing or other experience with revenue cycle management preferred.
• Experience working in a healthcare setting, or with HIPAA-protected data preferred.
• Highly detail-oriented; experience with manual data entry, tracking and auditing.
• Ability to perform basic computer functions using Microsoft Office.
• Ability to work well in a team.
• Excellent communication skills; ability to communicate warmly and clearly.
• Demonstrates a good awareness of self and ability to self-assess.
• Ability and desire to be in a work environment that values working as a team, relationships and giving and receiving honest feedback.
• A commitment to Ceres Community Project mission and operating principles.

Physical Demands / Work Environment

The physical demands described here are representative of those that must be met by a staff member to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to stand or sit at a workstation for an extended period of time; use hands and fingers to operate a computer keyboard and mouse; talk and hear to communicate with coworkers and clients over the phone.
• Light to moderate lifting of up to 30 pounds, bending, stooping and climbing a ladder is occasionally required.
• The work environment while in the office consists of moderate noise (i.e. nonprofit setting with office equipment, conversation from adjacent coworkers).

COVID-19

Ceres is following the guidance and requirements of the health departments of Sonoma and Marin counties, the state of California, and the CDC. We have extensive protocols in place for prevention of and response to COVID-19 and all new staff will be briefed on these in their onboarding. We need a commitment from all staff that they will abide by these protocols.

Operating Principles 

• Heart Centered & Love Guided - We are committed to expressing love, trust, respect and integrity in our lives, work, and organization.
• Everything Matters - Nothing is left out. We work to have every action and choice lead to the greatest positive impact.
• Young People are the Future - Young People are intelligent, responsible, capable, creative, and caring, and must be central participants in shaping our collective future.
• Equitable, Diverse, and Inclusive - We commit to championing policies and practices of social equity that build a diverse, inclusive, and healthy workplace and food system.

Ceres Organization 

Founded in 2007, Ceres Community Project works to build healthy communities by restoring whole, organic and locally grown food to its place as the foundation of health, empowering youth, and connecting people in heart-centered ways to others and the earth.

Ceres Community Project's main program, Healing Meals for Healthy Communities, provides free and low-cost nourishing organic meals, nutrition education and caring support to people facing serious illness. All of the meals are prepared by teens that learn about growing, cooking and eating healthy whole foods and the connection between diet and health, develop life and work-ready skills, and discover their power to make a difference. The Healing Meals Program improves healthy eating behaviors among clients, teens and adult volunteers and educates the whole community about the link between healthy eating and the health of both people and planet. It also strengthens the social fabric of the community, another factor that is at the root of health. In times of disaster, Ceres is an emergency nutrition provider for our community.

In addition to operating three program sites in Marin and Sonoma counties, Ceres has trained 14 communities nationally to replicate our model. We are also active at the state and national level in advocating for policies that support equitable access to healthy food and health care, including reimbursement for medically tailored meals by insurers. For more information, please visit www.ceresproject.org.

Ceres Community Project is an Equal Opportunity Employer. All employment decisions at Ceres are made without regard to race, color, religion, gender, sexual orientation, gender identity/expression, national origin/ancestry, age, disability, marital & veteran status or any other status protected by laws or regulations.