Community Action Partnership
Billing Specialist
Community Action Partnership, Santa Rosa, California, us, 95402
DescriptionBilling Specialist
Job Description
EXEMPT:
No
SALARY LEVEL:
$30 - $35 per hourDEPARTMENT:
Finance
LOCATION:
Remote with some in office work, Santa Rosa, CAREPORTS TO:
Director, Finance & Controller
HOURS:
FT (40 hours per week)Date:
03/25/2024
APPROVED BY:
Human Resources DirectorSUMMARY OF POSITION:
As the Enhanced Care Management and Community Supports Billing Specialist, you will be responsible for managing the billing and reimbursement processes associated with our specialized care programs through CalAIM learn. Your role involves collaborating with internal teams, verifying documentation, and ensuring compliance with relevant billing regulations.ESSENTIAL DUTIES AND RESPONSIBILITIES:
Duties include but are not limited to the following:Billing Process:Process billing for CAP Sonoma related to CalAIM ECM (Enhanced Care Management) and CS (Community Supports) services in compliance with program requirements.Ensure accurate and timely submission of claims to relevant payers.Documentation Verification:Review and verify supporting documentation to substantiate claims and reimbursement; ensure adherence to program guidelines.Collaborate with program team members to gather necessary information for billing and standardize reimbursement submission.Reimbursement Coordination:Work closely with payers to secure timely and accurate reimbursement.Address any issues or discrepancies in reimbursements.Compliance and Regulations:Stay informed about relevant billing regulations, coding updates, and program-specific requirements.Ensure adherence to all billing and documentation guidelines to maintain compliance.Communication and Collaboration:Collaborate cross-functionally with program management, finance, and administrative teams to resolve billing-related inquiries and discrepancies.Provide support in training staff on billing processes and requirements.Perform other duties as assigned.PREFERRED EDUCATION AND EXPERIENCE:
Bachelor’s Degree and/or 4-6 years of experience in medical billing; nonprofit or healthcare system preferred.REQUIRED SKILLS/ABILITIES:
Knowledge of MediCal billing processes and regulations; experience with CalAIM and Partnership Healthplan a plus.Familiarity with TARs and relevant HCPCS, CPT, and ICD codes.Detail-oriented with strong analytical and problem-solving skills.Advanced proficiency with Microsoft Excel and Word.Excellent communication and interpersonal skills.WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. This job operates in a professional office and home office environment. The noise level in the work environment is usually moderate.PHYSICAL DEMANDS:
While performing the duties of this job, the employee is frequently required to sit; use the computer keyboard and mouse, use hands to finger, handle or feel; reach with hands and arms; and talk or hear. The employee may occasionally be required to stand, walk, stoop, and crouch.OTHER DUTIES:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
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Job Description
EXEMPT:
No
SALARY LEVEL:
$30 - $35 per hourDEPARTMENT:
Finance
LOCATION:
Remote with some in office work, Santa Rosa, CAREPORTS TO:
Director, Finance & Controller
HOURS:
FT (40 hours per week)Date:
03/25/2024
APPROVED BY:
Human Resources DirectorSUMMARY OF POSITION:
As the Enhanced Care Management and Community Supports Billing Specialist, you will be responsible for managing the billing and reimbursement processes associated with our specialized care programs through CalAIM learn. Your role involves collaborating with internal teams, verifying documentation, and ensuring compliance with relevant billing regulations.ESSENTIAL DUTIES AND RESPONSIBILITIES:
Duties include but are not limited to the following:Billing Process:Process billing for CAP Sonoma related to CalAIM ECM (Enhanced Care Management) and CS (Community Supports) services in compliance with program requirements.Ensure accurate and timely submission of claims to relevant payers.Documentation Verification:Review and verify supporting documentation to substantiate claims and reimbursement; ensure adherence to program guidelines.Collaborate with program team members to gather necessary information for billing and standardize reimbursement submission.Reimbursement Coordination:Work closely with payers to secure timely and accurate reimbursement.Address any issues or discrepancies in reimbursements.Compliance and Regulations:Stay informed about relevant billing regulations, coding updates, and program-specific requirements.Ensure adherence to all billing and documentation guidelines to maintain compliance.Communication and Collaboration:Collaborate cross-functionally with program management, finance, and administrative teams to resolve billing-related inquiries and discrepancies.Provide support in training staff on billing processes and requirements.Perform other duties as assigned.PREFERRED EDUCATION AND EXPERIENCE:
Bachelor’s Degree and/or 4-6 years of experience in medical billing; nonprofit or healthcare system preferred.REQUIRED SKILLS/ABILITIES:
Knowledge of MediCal billing processes and regulations; experience with CalAIM and Partnership Healthplan a plus.Familiarity with TARs and relevant HCPCS, CPT, and ICD codes.Detail-oriented with strong analytical and problem-solving skills.Advanced proficiency with Microsoft Excel and Word.Excellent communication and interpersonal skills.WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. This job operates in a professional office and home office environment. The noise level in the work environment is usually moderate.PHYSICAL DEMANDS:
While performing the duties of this job, the employee is frequently required to sit; use the computer keyboard and mouse, use hands to finger, handle or feel; reach with hands and arms; and talk or hear. The employee may occasionally be required to stand, walk, stoop, and crouch.OTHER DUTIES:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
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