Medi-Cal Billing Specialist

Job Description

Job Description

Position Overview

We are seeking a highly detail-oriented and experienced Medi-Cal Billing Specialist to join our team. The ideal candidate will have a strong understanding of Medi-Cal billing procedures, claims submission, payer guidelines, and reimbursement processes. This role requires expertise in behavioral health and / or substance use disorder treatment billing, with the ability to handle complex claim scenarios, resolve denials, and ensure compliance with state and federal regulations.

Key Responsibilities

• Prepare, review, and submit Medi-Cal claims accurately and in a timely manner through appropriate clearinghouses and payer portals.
• Ensure billing complies with Medi-Cal regulations, codes, and payer-specific requirements.
• Verify patient eligibility, authorization, and coverage details before claim submission.
• Research, analyze, and resolve denied, rejected, or underpaid claims.
• Track aging reports and follow up with Medi-Cal and other payers to ensure maximum reimbursement.
• Maintain accurate documentation of billing activity, payment postings, and appeals.
• Collaborate with clinical, intake, and utilization review teams to reconcile authorization and billing discrepancies.
• Stay current on Medi-Cal updates, including rate changes, policy updates, and compliance requirements.
• Generate regular reports for management, highlighting collection trends, reimbursement issues, and outstanding AR.

Qualifications

Minimum 3–5 years of hands-on Medi-Cal billing experience, preferably in behavioral health, mental health, or substance use disorder treatment settings.

Proficiency in medical billing software and electronic health record (EHR) systems.

Familiarity with other payer guidelines (Medicare, commercial insurance, managed Medi-Cal plans).

Compensation & Benefits