JOB SUMMARY:

We are seeking a detail-oriented and organized Billing Clerk to join our team. The successful candidate will be responsible for processing and managing billing for Enhanced Case Management (ECM), Community Health Worker (CHW), and Targeted Case Management (TCM) services. The Billing Clerk will ensure accurate and timely billing, follow up on claims, and maintain compliance with regulatory requirements.

REQUIREMENTS:

1. Education: A high school diploma or equivalent is required; an associate’s degree in a related field is preferred.
2. Experience: 1-2 years of experience in medical billing or a related field.
3. Skills:
   a. Strong attention to detail and organizational skills.
   b. Excellent communication and customer service skills.
   c. Ability to work in a fast-paced environment and prioritize tasks effectively.
   d. Proficiency in medical billing software and electronic health records (EHRs).

PREFERRED QUALIFICATIONS:

1. Certification: Medical billing certification (e.g., CMC, CMRS) preferred.
2. Experience with Medicaid billing: Familiarity with Medicaid billing regulations and procedures.
3. Knowledge of CHW services: Understanding Community Health Worker services and billing requirements.
4. Experience with billing software: Proficiency in billing software, such as Office Ally.

1.
a. Process and submit claims for ECM, CHW, and TCM services promptly and accurately.
b. Ensure compliance with billing regulations, including Medicare, Medicaid, CalOptima, Partnership Health Plan, Molina, Superior, Blue Cross, and other payers.
c. Follow up on claims to ensure payment and resolve any issues.
2.
a. Accurately enter billing data into the billing system.
b. Maintain accurate and up-to-date records of billing and payment activity.
3.
a. Track and manage reimbursements from payers.
b. Ensure accurate payment posting and follow up on any discrepancies.
4.
a. Ensure compliance with billing regulations and maintain knowledge of changes to regulations.
b. Generate reports as needed to support billing and reimbursement activities.
5.
a. Collaborate with CHWs, case managers, and other staff to ensure accurate billing and reimbursement.
b. Communicate with payers, providers, and other stakeholders to resolve billing issues.