Aviva Family and Children’s Services Mission Statement

Aviva believes every child and every family in our Los Angeles community deserves the chance for a brighter future. We provide compassionate support, therapeutic services, and guidance to at-risk children and families.

Job Summary

Under the supervision of the Billing Coordinator, the Billing Specialist performs high volume advanced (senior-level) data entry work. Work involves entering, verifying, researching, coding, correcting, or retrieving information from source documents and/or computer system with a high level of accuracy. Billing Specialists are expected to have a thorough understanding of batch processing and FTP files, an ability to interpret error reports and diagnose issues with data entry applications as well as execute correction procedures and processes.

Essential Functions

• Bill Private Health and County/State EPSDT Insurances. Prepare and submit claims either electronically or by paper. Contact insurance companies in order to correct billing issues and resubmit claims to third-party payers.
• Perform 5010 837 billing transactions and 835 response file from DMH LA County and other health coverage. Decode transactions and file response to identify billing errors. Follow and report on status of all billing transactions.
• Create and maintain reports from application database by tracking billings; monitoring collections; compiling information.
• Determine eligibility using the 270/271 interface along with the state system. Review each client’s eligibility status for appropriate assignment. Identify problems with eligibility files and translate them into a functional report that allows staff to appropriately report claims.
• Work in Crystal Reports
• Act as a liaison between application and staff. Facilitate open lines of communication with clients in order to evaluate ability to pay.

Competency Requirements

• Knowledge of medical billing/collection practices and third-party operating procedures and practices
• Ability to speak, read, write and understand English
• Excellent inter-personal, grammar, critical and analytical thinking skills
• Understanding of computer systems and proficiency in applications such as Microsoft Word, Access, and Excel.

Education and Experience

• Minimum 3 years’ experience with Crystal Reports
• Minimum 2 years’ experience with medical billing
• Experience with billing Private Health Insurances.
• Experience with 5010 837 billing transaction and 835 response file from DMH LA County and other health coverage.

Certifications/Licenses

• Valid CA driver’s license

Additional Requirements

• Tuberculosis clearance
• Department of Justice/Fingerprint clearance
• Satisfactory completion of health screening
• Proof of legal eligibility to work in the United States
• Satisfactory driving record

Delegates Authority To

N/A

Physical Demands

While performing the duties of a Billing Specialist, the employee is frequently required to sit, stand and use his/her fingers to manipulate a keyboard or writing instrument. The employee is occasionally required to walk, and bend.

Work Environment

The work environment is primarily indoors. The noise level varies from quiet to loud.

This Job Description has been developed to identify some of the duties and responsibilities of this position. It is not intended to limit or encompass all duties and responsibilities of the position. Aviva Family and Children's Services at its sole and absolute discretion, expressly reserves the right to modify, supplement, delete or augment the duties and responsibilities specified in this and all job descriptions.