Medical Biller (full-time)

Entity: Dream Center
Department: Cal-AIM
Location: Los Angeles Dream Center
Level/Salary Range: $22/hour

Job Purpose:

The Dream Center’s purpose is to reconnect isolated people to God and a community of support by providing human services that address immediate and long-term needs in the areas of homelessness, hunger, poverty, addiction, education, and human trafficking. We are building a community of overcomers, people whose lives have been redeemed by God’s love, justified by faith, and born again upon repentance and acceptance of Jesus Christ as Lord.

The Cal-AIM billing specialist will manage the day-to-day administrative operations of the ECM and CS services rendered by the Dream Center. The billing specialist will also provide Cal-AIM specialized billing services along with other billing duties.

Duties:

• Submit invoices to the managed care plans (MCPs: Medical Care Plans) for multiple CS and ECM rendered services on a single day for a single client/guest/member.

• Submit claims for the services rendered with CS and ECM authorized clients.

• Ensure data is up to date in billing software and electronic medical record (EMR) database.

• Authorize clients for CS and ECM services and stay current with those authorizations/referrals on a regular basis.

• Check eligibility with clients MCP before billing and maintain client remains eligible to receive services for the duration of the time they are enrolled in a Dream Center residential program.

• Responsible for correcting, completing, and processing claims of all respective payer codes.

• Maintain strictest confidentiality; adheres to all HIPPA guidelines/regulations.

• Contribute to every stage of revenue cycle from claims submissions to denial management, to payment posting review and reporting.

• Coordinate with other departments to obtain and analyze additional information about clients/guest/members to be able to record process billing effectively.

• Ensure that maximum reimbursement is obtained through billing and coding of all services rendered.

• Responsible for correcting, completing, and processing claims of all respective payer codes.

• Daily monitoring of assigned queues for claim progression directly impacting timely payments.

• Manage the claims process, including accurate and timely claim creation, follow-up and correspondence with providers and insurance inquires/correspondence.

• Prepare and submit clean claims to third-party payers either electronically or by paper per the payor guidelines.

• Submit claims for the provision of CS and ECM related services to MCPs using the national standard specifications and code sets to be defined by DHCS.

• Attend any online training and ensures to keep up to date with any compliance related materials from each MCP.