Claims Specialist

Every person deserves compassion, dignity, and the safety of a place to call home.”

Homelessness is the largest social and public health crisis in California. Illumination health home is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care centers, emergency shelters, housing services and children's and family programs. IF currently has 13 facilities with 22 micro-communities scattered across Orange County, Los Angeles County and the Inland Empire.

Job Description

The role of a Billing Claims Specialist involves overseeing the billing process for customers or patients, processing payments, maintaining financial records, and ensuring accurate billing and claims submissions. In addition, the Claims specialist is also responsible for keeping account receivables for CalAIM current, claim follow-up and escalation, and must have knowledge of billing codes and standard procedures.

The pay rate for this role is $25-$27 per hour.

The schedule for this role is a hybrid schedule with Monday/Thursday in office and Tuesday/Wednesday/Friday WFH.

Responsibilities:

CalAIM Billing and Follow up

• Reviewing data and creating Claims for services rendered
• Ensure claims meet the standards of our contracts and programs.
• Verifying authorizations via provider portals or authorization letters on Kipu prior to claim submission.
• Verifying eligibility prior to claim submission via provider or DHCS portals
• Review client records to extract applicable data necessary for billing purposes, including but limited to ICD 10 Diagnosis codes, CPT codes for services rendered etc.
• Review and follow up on outstanding account receivables
• Review any rejected or denied claims and conduct proper follow up procedures (Escalations/Appeals/Claim corrections)
• Monitor and maintain county aging and escalating trends, write offs, etc.
• Have knowledge in understanding, reading EOB’s and Remittance Advice
• Posting payment accurately to claims and continuing with the claim close out process
• Assist supervisors in any projects related to billing that may come up
• Attend monthly team meetings or trainings at Corporate location
  
  

Expectations:

• Communicate with tact and professionalism
• Be able to meet targets and work under pressure with a high volume of claims
• Maintain knowledge of industry standard CMS guidelines for Billing
• Must be motivated to work independently as well as in a group setting.
  
  

Minimum Qualifications/Preferred Experience:

• High School Diploma or equivalent.
• 1-2 years' relevant experience.
• Basic computer skills, including the ability to send and receive emails and summarize data in spreadsheets.
• Prior experience work in Electronic Billing Platforms and EHR systems
• Prior experience working with claims and communication with health networks
• Proficiency in Microsoft (Mail, Docs, Sheets, Calendar).
• Associate's degree or higher
• Medical Billing Certificate
• Experience in Medical Billing and Primary Care Billing
  
  

Benefits

• Medical Insurance funded up to 91% by Illumination Health Home (Kaiser and Blue Shield), depending on the plan
• Dental and Vision Insurance
• Life, AD&D and LTD Insurance funded 100% by Illumination Health Home
• Employee Assistance Program
• Professional Development Reimbursement
• 401K with Company Matching
• 10 days vacation PTO/year
• 6 days of sick pay/year
• Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans
  
  

Powered by JazzHR

jfXusSa1yG