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Billing & Claims Specialist - Medi-cal Calaim
3 months ago
**About Omatochi**:
Omatochi is a leading home care service provider dedicated to enhancing the quality of life for our clients. We specialize in delivering compassionate and high-quality care with a focus on personalized solutions. As we continue to grow, we are seeking a skilled Billing Specialist to join our team and contribute to the success of our Medi-Cal CalAIM program.
**Job Overview**:
**Responsibilities**:
**Claims Processing**:
- Accurately prepare and submit claims for services rendered to Medi-Cal CalAIM, ensuring compliance with program guidelines and regulations.
- Review and verify the completeness of claims documentation, resolving any discrepancies or issues promptly.
**Billing and Reimbursement**:
- Collaborate with internal teams to gather necessary information for billing purposes.
- Monitor reimbursement activities, identifying and addressing any billing errors or discrepancies.
**Program Compliance**:
- Stay updated on changes to the Medi-Cal CalAIM program regulations, policies, and billing procedures.
- Ensure strict adherence to program requirements and maintain compliance with all relevant guidelines.
**Documentation and Record-Keeping**:
- Maintain accurate and organized records of billing transactions, claims submissions, and related documentation.
- Prepare reports and summaries as required for internal and external audits.
**Communication and Collaboration**:
- Communicate effectively with internal stakeholders, including care managers and administrative staff, to address billing-related inquiries and resolve issues.
- Collaborate with external entities, including Medi-Cal representatives and regulatory bodies, to facilitate smooth billing processes.
**Qualifications**:
- Bachelor's degree in Healthcare Management, Business Administration, or a related field.
- Minimum of 3 years of experience in billing and claims processing, with a focus on Medi-Cal programs.
- In-depth knowledge of the Medi-Cal CalAIM program regulations, guidelines, and billing procedures.
- Proficiency in using billing software and electronic health record (EHR) systems.
- Strong attention to detail and accuracy in claims submission and documentation.
- Excellent communication skills and the ability to collaborate effectively with cross-functional teams.
- Familiarity with relevant laws and regulations governing healthcare billing practices.
**What We Offer**:
- Competitive salary commensurate with experience.
- Comprehensive benefits package, including health insurance plans.
- Opportunities for professional development and career advancement.
- A supportive and inclusive work environment.
