Job Detail

POSITION TITLE: Billing Specialist

DUTIES AND RESPONSIBILITIES:

Under the direct supervision of the Manager of Substance Use Services, the Billing Specialist will:

• Process and submit billing for reimbursement from Medi-Cal, other private insurance, Public-Private partnerships and other sources.
• Input client authorizations on PCNX and notify LPHA and SUD Counselor when authorization requirements are due.
• Attend provider meetings and review updates on new billing rules and requirements with Program Manager
• Communicate with SAPC to make requested changes and provide QIUM with requested information
• Develop, document and implement mechanisms and controls to Medi-Cal ensure appropriate billing and payment cycles and accurate timely billing, in accordance with internal and third-party payor requirements.
• Possess knowledge of Exym electronic billing and PCNX
• Develop, document and implement appropriate billing policies and procedures for all billing activities including follow up.
• Review and process claims, denied claims, resubmitting or appealing unpaid claims.
• Review patient charts for accuracy and completeness, signatures and assembly in accordance with agency reimbursement requirements.
• Communicate immediately to Manager of Substance Use Services all compliance related problems and unresolved processes and claims.
• Route charts to follow-up; perform data entry; prepares statistical and other reports related to billings.
• Reconcile Medi-Cal billing.
• Research and obtain incomplete or additional information for billing requirements.
• Run weekly and monthly reports to provide to Finance Department and Manager of Substance Use Services
• Enter data and manipulate using Excel
• Assist with budget modification to shift funding allocation between programs.
• Must be self-sufficient and be able to multi-task
• Any other tasks/duties required for business needs.

Requirements:

• Minimum of 3-5 years of experience with Medi-Cal Billing and claims. Knowledge of Medi-Cal coding.
• Must be knowledgeable of insurance guidelines, Medi-Cal terminology, HIPAA compliance guidelines, protocols and procedures to protect clients information and confidentiality.
• The ability to work effectively with a wide range of people, team managers, supervisors, directors and vendors.
• Must be proficient with MS Word, Excel, Spreadsheets, IHBIS and Exym.
• Ability to pass background check and criminal clearance.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made, if requested, to enable individuals with disabilities to perform the essential functions.

HYC, INC. IS AN EQUAL OPPORTUNITY EMPLOYER. EMPLOYMENT CONSIDERATION IS MADE WITHOUT REGARD TO AGE, RACE, COLOR, RELIGION, GENDER, GENDER IDENTITY, GENDER EXPRESSION, SEXUAL ORIENTATION, MARITAL STATUS, NATION ORIGIN, ANCESTRY, MILITARY OR VETERAN STATUS, INCLUDING PHYSICAL OR MENTAL DISABILITIES OR ANY OTHER LEGALLY PROTECTED STATUS.