Medical Billing & Claims Specialist

Job Title: Medical Billing & Claims Specialist

Work Location: Merced, CA (In-Person)

Position Type: Part-time, 20-25 hours per week

Pay: $24.00 - $30.00 / hour, depending on experience and qualifications

Insurance Benefits: Not eligible

Time Off: 5 sick days, 16 paid holidays, vacation, and annual company time off. 

Reports To: Chief Finance Officer

About Us: 

United Way of Merced County is at the forefront of integrating innovative health solutions to improve patient outcomes, particularly for those with complex health needs. As part of the CalAIM initiative, we are committed to transforming our community's healthcare landscape by delivering comprehensive Enhanced Care Management (ECM) and Community Supports (CS) services. We aim to address social determinants of health, reduce health disparities, address chronic conditions by collaborating with healthcare partners, and ensure high-quality care for all members.

Position Overview

We are seeking a detail-oriented Claims Specialist to support billing and claims submission for our CalAIM Enhanced Care Management (ECM), Community Supports (CS), and Community Health Worker (CHW) programs. This part-time position is responsible for ensuring timely and accurate claims submission, monitoring payment activity, and following up on denials or rejections. The role is hands-on and essential to keeping our programs financially healthy and in compliance with Medi-Cal and health plan requirements.

Key Responsibilities

• Prepare, submit, and track claims to managed care plans for ECM, CS, and CHW services.
• Review encounter and service documentation for billing accuracy and compliance.
• Identify and correct claim errors, denials, and rejections; resubmit as needed.
• Post payments and adjustments; reconcile accounts receivable.
• Maintain up-to-date records of claims activity and status.
• Communicate with payers regarding outstanding claims or payment issues.
• Collaborate with program staff to ensure documentation supports billing requirements.
• Protect confidential patient information and follow HIPAA and Medi-Cal guidelines.

Recommended Competencies and Skills

• Strong customer service skills.
• Demonstrated ability to provide care, compassion, and empathy to our clients.
• Excellent communication and interpersonal skills.
• Cultural sensitivity, awareness, and knowledge.
• Strong problem-solving skills.
• Adaptability and resilience, with the ability to thrive in a dynamic, fast-paced environment.
• Ability to work independently and communicate effectively with your supervisor.

Qualifications 

• Valid California Driver's license. Must have own reliable transportation with proof of valid auto insurance.
• Proficient in using electronic computer systems and applications.
• Ability to walk frequently. Ability to lift and carry 10-15 pounds on a regular basis. Ability to physically meet the demands of this job. Must be able to sit or stand for long periods of time.
• 1–2 years of experience in medical billing or claims processing (Medi-Cal or managed care experience strongly preferred).
• Familiarity with CalAIM ECM/CS programs, CHW billing, or similar Medi-Cal initiatives is a plus.
• Familiarity with healthcare billing codes (CPT, HCPCS, ICD-10) a plus.
• Proficiency with electronic health record (EHR) and billing platforms.
• Excellent attention to detail, problem-solving, and organizational skills.
• Ability to work independently and manage deadlines.

Why Join Us

United Way of Merced County offers a vibrant, supportive, and collaborative environment where your work will have a direct impact on improving patient care and outcomes. Join us in shaping the future of healthcare in our community. We are committed to building a broadly diverse community, nurturing a welcoming and supportive culture, and engaging diverse ideas for providing culturally competent care.