What are the responsibilities and job description for the Billing Coordinator III position at Interface Children & Family Services?
Exemption Status: Non-Exempt
Reports to: Director, Community Wellness and Coordinated Care
Salary: $23.00 / hour $1.00 bilingual incentive upon passing certification
Summary: The Billing Coordinator III is a key member of the Community Wellness and Coordinated Care team and assists the Director with billing, reporting, and authorization duties. This role involves managing reporting to managed care plans (MCP), claims processing, authorization coordination, and maintaining compliance with healthcare billing regulations while ensuring accurate and timely submission of claims.
Key Responsibilities:
- Authorization Coordination:
- Submit authorizations following eligibility verification from care team
- Maintain regular correspondence with care team leadership regarding authorization status
- Track and document all authorization submissions and responses
- Ensure timely follow-up on pending authorizations
- Claims Preparation and Processing:
- Collect and organize required documentation for individual claims through program software
- Conduct thorough review and quality checks of client and provider information
- Verify accuracy of billing codes and ensure proper application
- Maintain organized filing system for all claims documentation
- Claims Submission Management:
- Collaborate with the financial department in submitting claims
- As needed, assist with generating accurate invoices based on service documentation
- Compile reporting/billing packages and provide to financial department for submission and processing
- Claims Status Tracking and Resolution:
- Regularly monitor claims status through appropriate platforms
- Process and track incoming paper claims and MCP billing correspondence
- Address claim denials from MCP or Clearinghouse by:
- Analyzing denial codes
- Implementing necessary corrections
- Resubmitting claims and monitoring revised status
- Coordinate with financial department for payment processing
- Maintain detailed records of all claim resolutions
- Compliance and Quality Assurance:
- Responsible for the member-level information sharing processes with MCP
- Stay current with DCHS and MCP regulations and policy updates
- Participate in billing-related training, conferences, and webinars
- Maintain effective communication with MCP representatives
- Conduct regular quality assurance reviews of reporting files and billing records
- Implement and maintain proper record-keeping procedures
- Team Collaboration and Communication:
- Participate in regular team meetings and billing coordination conferences
- Maintain open communication with the Community Wellness and Coordinated Care Management
- Collaborate with care team members to ensure accurate service documentation
- Documentation and Reporting:
- Maintain accurate and timely documentation of all billing activities
- Generate regular reports on claims status and resolution
- Document and track authorization outcomes
- Prepare analysis of denial patterns and resolution strategies
Desired Qualifications:
- Bachelor’s degree in healthcare administration, business administration, or related field preferred; or equivalent experience
- Minimum of 1-2 years of experience in healthcare billing, claims processing, finance department or related field
- Knowledge of Medi-Cal benefits programs and billing requirements
- Experience with healthcare billing software and electronic claims submission
- Strong attention to detail and analytical skills
- Excellent organizational and time management abilities
- Proficiency in medical billing systems and documentation platforms
- Understanding of healthcare billing codes and regulations
- Valid driver’s license and ability to travel within the service area when required
- Successful background and criminal clearance required and maintained, including but not limited to California Department of Justice (DOJ), Federal Bureau of Investigation (FBI), Child Abuse Index and Department of Motor Vehicles (DMV)
- Proof of valid California Driver’s License, reliable transportation, proof of automobile insurance (listed as covered), pass and maintain driving approval as required by our insurer
- Bilingual Preferred: upon passing certification, preferred for potential daily use
Salary : $23