Contracts and Billing Specialist

Company Overview

Community Care Management Corp. is a non-profit organization dedicated to empowering frail, ill, and disabled individuals to maintain their independence and dignity while living at home. Our mission is to provide comprehensive support services that enhance the quality of life for our clients.

Summary

The Contracts and Billing Specialist works in various capacities. The Contracts and Billing Specialist acts as liaison with the State for submission and receipt of client and service data and subcontractor reports; assists HR & Accounting Manager as lead role in negotiating, preparing, and maintaining vendor subcontracts for the provision of client services. Serves as a staff resource for vendors, monitoring for compliance with State guidelines. S/he submits monthly client eligibility data, processes client and service data, prepares and submits monthly and quarterly billing summaries and invoices, and generates reports. The Contracts and Billing Specialist bills Medi-Cal for verified, delivered client services.

Responsibilities

• Acts as vendor subcontract liaison with the Ca. Dept. of Aging (CDA), Ca. Dept. of Public Health (CDPH), and Office of AIDS (OA), and maintains subcontract language in compliance with State policies.
• Maintains service definitions as defined by State and Waiver guidelines.
• Compiles the annual subcontractor licensure report as part of CDA’s first quarterly report, and provides subcontractor information to program Directors for reporting to State Agencies.
• Creates monthly caseload count, client files, service files, and eligibility batches and submits to appropriate Agencies on a monthly and quarterly basis.
• Participates in Utilization Reviews, Site Monitoring Visits, and Audits as required.
• Produce monthly and quarterly invoices for all program contracts, grants, and micro-grants.
• Create invoices, receive payments, update records, and monitor inventory in QuickBooks.
• Imports into MSSPCare the PCSP file received from CDA, which deposits delivered referred services data required on MSSP Service Planning Utilization Summaries (SPUS). Prints and proofs 100% verified SPUS’s and distributes to care managers for signatures.
• Sources potential vendors, and serves in lead role in negotiating and preparing rates and terms of MSSP and CCHAP subcontract agreements.
• Helps to create accounts with non-subcontracted vendors, working with Case Management (CM) staff as needed to obtain necessary documents.
• Provides vendor data to CM staff, i.e. contracted dates, rates, and rate details.
• Updates and maintains vendor Provider Indexes and distributes to CM staff.
• Maintains and updates service ordering procedures.
• Provides assistance as needed to clarify appropriate use of service codes, client forms, work orders, and reports.
• Downloads electronic client eligibility files and maintains proof of eligibility.
• Assists in quality control usage of CDA service codes and data entry into services database.
• Processes Work Order Service Authorizations from Service Planning and Utilization Summaries (SPUS) and enters into MSSPCare Medi-Cal billing software.
• Compiles, prints, reconciles, and distributes various fiscal reports.
• Prepares, submits and tracks Medi-Cal electronic and paper claim billings, including adjustments and appeals to claim denials. Follows approved Medi-Cal guidelines for completion of claim forms.
• Supports HR & Accounting Manager in calculating final Care Management (CM) and Care Management Support (CMS) billing rates to close out each fiscal year, based on reimbursements and client caseload. Generates and submits Fiscal Summary Report at fiscal closeout time.
• Submits requests to CDA for adjusted rates as necessary to ensure optimum reimbursement of services.
• Maintains Medi-Cal billing procedural manual, and works in partnership with MSSPCare software tech support to comply with Medi-Cal changes.
• Travels as necessary to develop vendor contracts, train staff on service ordering procedures, attend State meetings and trainings, and attend seminars, workshops, meetings, etc.
• Collaborates with Accounting Manager to update, define and maintain other funding grant procedures for staff.

Requirements

• Coursework in Business Administration with an emphases in Accounting, Finance, and/or Business Development.
• Experience in grant and contract negotiation and biling.
• Familiarity with and understanding of Generally Accepted Accounting Principles (GAAP) preferably in a not-for-profit environment.
• Experience in Medi-Cal billing preferred
• Grant writing and development preferred

Additional Requirements

• All employees must pass State and Federal Live Scan background check before the start of employment.
• All employees of Community Care must carry the State of CA minimum bodily injury liability insurance on vehicles used for work.

Work Environment

The workspace for the Contracts and Billing Specialist is located in a shared office space. Frequent interruptions from fellow staff members and vendors is expected. The sound level is generally low to moderate. Occasional local travel to run errands and perform essential functions of the job is to be expected. The Contracts and Billing Specialist is required to take occasional trips to other sites, State and vendor’s offices, etc., and outside the County to attend training, department meetings, and attend Agency events.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made to enable individuals with disabilities to perform these functions provided those accommodations pose no danger or threat to the employee, staff, clients, vendors, etc, or create undue hardship for the Agency or its staff.

While performing the duties of this job, the employee is required to have ordinary ambulatory skills sufficient to visit other locations, and the ability to stand, walk, stoop, kneel, crouch, and manipulate (lift, carry, move) light to medium weights of 10-50 pounds. Requires good hand-eye coordination, arm, hand and finger dexterity, including ability to grasp, and visual acuity to use a keyboard. The employee frequently is required to sit for long periods of time, reach with hands and arms, talk and hear. Ability to operate a motor vehicle in order to visit other sites, and run errands. The Contracts and Billing Specialist must be able to transport files and binders.

If you are passionate about making a difference in the community, we invite you to apply today and join our dedicated team at Community Care Management Corp!

Job Type: Full-time

Pay: $27.28 - $29.81 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: In person

Salary : $27 - $30