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Billing Claims SpecialistEvery 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.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 include:Reviewing data and creating claims for services renderedEnsuring claims meet the standards of our contracts and programsVerifying authorizations via provider portals or authorization letters on Kipu prior to claim submissionVerifying eligibility prior to claim submission via provider or DHCS portalsReview 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 receivablesReview 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 AdvicePosting payment accurately to claims and continuing with the claim close out processAssist supervisors in any projects related to billing that may come upAttend monthly team meetings or trainings at Corporate locationExpectations: Communicate with tact and professionalismBe able to meet targets and work under pressure with a high volume of claimsMaintain knowledge of industry standard CMS guidelines for BillingMust 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 systemsPrior experience working with claims and communication with health networksProficiency in Microsoft (Mail, Word, Excel, Calendar).Associate's degree or higherMedical Billing CertificateExperience in Medical Billing and Primary Care BillingBenefits:Medical Insurance funded up to 91% by Illumination Health + Home (Kaiser and Blue Shield), depending on the planDental and Vision InsuranceLife, AD&D and LTD Insurance funded 100% by Illumination Health + HomeEmployee Assistance ProgramProfessional Development Reimbursement401K with Company Matching10 days vacation PTO/year6 days of sick pay/yearPotential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans
