Illumination Health + Home
Claims Specialist
Santa Ana, CA - 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 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.
Role
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 Wednesday/Friday in office and Monday/Tuesday/Thursday WFH. 8:00am - 4:30pm.
Responsibilities
CalAIM Billing and Follow up
Reviewing date and creating claims for services rendered.
Ensure claims meet the standards of our contracts and programs.
Verifying authorizations via provides portals or authorization letters on KIPU prior to claim submission.
Verifying eligibility prior to claim submission via provider or DHCS portals.
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 and follow up on outstanding account receivables.
Review any rejected or denied claims and conduct proper follow up procedures (escalations, appeals, and claim correction.)
Monitor and maintain county aging and escalating trends, write offs, etc.
Have knowledge in understanding, reading EOB's and Remittance Advice.
Posting payment accurately to claims and continuing with the claim close out process.
Assist supervisors in any projects related to billing that may come up.
- Attend monthly team meetings or trainings at corporate location.
Expectations
- Communicate with tact and professionalism
- Be able to meet targets and work under pressure with a high volume of claims
- Maintain knowledge of industry standard CMS guidelines for billing.
- Must be motivated to work independently as well as in a group setting
- Fulfill Illumination's guiding principles of integrity, humility, sustainable compassion, quest
- for knowledge and critical thinking, client-centered care, innovation, advocacy, stewardship, and compliance.
Minimum Qualifications/Preferred Experience
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.
Prior experience work in Electronic Billing Platforms and EHR systems
- Prior experience working with claims and communication with health networks
Preferred:
- Proficiency in Microsoft (Mail, Docs, Sheets, Calendar).
Associate's degree or higher
Medical Billing Certificate
- Experience in Medical Billing and Primary Care Billing
Benefits
- 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 of sick pay/year
- Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans
