Claims Specialist

Job Description

Job Description

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, Word, Excel, Calendar).

Associate's degree or higher

Medical Billing Certificate

• Experience in Medical Billing and Primary Care Billing

Benefits

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