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Claims Specialist

4 months ago

Santa Ana, United States Illumination Foundation Full time
"Every 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 Foundation (IF) 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.

Job Description
The Claims Specialist is responsible for accuracy of claims submission, benefits and eligibility verification, accuracy of client information. In addition, the Claims Specialist is also responsible for keeping up to date accounts receivable for both CalAIM and IFMG, claim follow-up, and must have knowledge of billing codes.
The pay range for this position is $25.00 - $27.00 per hour, depending on experience. This position can be based out of Santa Ana or Riverside. After successful completion of 90-day probation period, this position will be eligible for Hybrid schedule with 2 days in office and 3 days working from home.

Responsibilities
CalAIM Billing and Follow up
  • Reviewing data and creating Claims for services rendered
  • Review 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 any rejected or denied claims and conduct proper follow up procedures.
  • Ensure claims meet the standards of our contracts and programs.
  • Verify eligibility of each client prior to creating and submitting claims.
  • Have knowledge in understanding, reading EOB's and Remittance Advice
  • Posting payment accurately to claims and continuing with the claim close out process.
  • Assist Manager and Associate Director in any projects related to billing that may come up.
IFMG Billing and Follow up
  • Reviewing encounters for PCP, Psychiatry, and behavioral health, ensuring CPT codes, and ICD 10 codes used by Dr are applicable to the service rendered before submitting encounter as a claim.
  • Familiar with Athena or similar EHR system
  • Verifying client's insurance falls into one our contracted insurance prior to billing
  • Following up on claims that were denied, rejected, or held in the EHR system which includes appeals, corrections, resubmissions
Preferred Experience/Minimum Qualifications

Required:
  • 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.
  • Valid CA Driver's License and eligibility for company vehicle insurance.
  • Prior experience work in Electronic Billing Platforms and EHR systems
  • Prior experience working with claims and communication with health networks
Preferred:
  • Proficiency in Microsoft (Outlook, Word, Excel, Teams).
  • Associate's Degree
  • Bachelor's degree
  • Experience in Medical Billing and Primary Care Billing
  • Medical Billing Certification
Benefits
  • Hybrid schedule with 2 days in office and 3 days working from home (After successful completion of 90-day probation period)
  • Medical Insurance funded up to 91% by Illumination Foundation (Kaiser and Blue Shield), depending on the plan
  • Dental and Vision Insurance
  • Life, AD&D and LTD Insurance funded 100% by Illumination Foundation
  • Employee Assistance Program
  • Professional Development Reimbursement
  • 401K with Company Matching
  • 10 days vacation PTO/year
  • 6 days sick PTO/year
  • 10 days holiday PTO/year
  • Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans