JOB TITLE: Billing/Authorization Specialist

SUMMARY
Stay Focused Ministries Billing/Authorization Specialist handles daily authorization requests for various services as well as day to-to-day administrative operations. This individual plays a vital role in billing for programs and will also provide CalAIM-specialized billing services. This position entails answering a high volume of phone calls and emails. The successful candidate will be able to ensure an elevated level of customer service, maintain positive relationships within the company, and maximize productivity by reviewing the accuracy of data processing. The billing/authorization specialist must be able to operate in a fast-paced environment, manage difficult conversations, be thoughtful, resourceful, collaborative, and customer-focused.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Supports and promotes the mission of the Agency.
• Prepare and submit invoices and claims to required entities.
• Manage a high volume of provider calls and emails – time management and efficiency are critical.
• Review and analyze authorization requests by navigating multiple systems and platforms and accurately capturing the data/information for processing.
• Ensure timely verification and validation of authorizations for all clients and other services as assigned, as well as that maximum reimbursement is obtained through billing and coding, or all services rendered. Responsible for correcting, completing, and processing claims of all respective payer codes.
• Communicate effectively, build and maintain professional, cooperative relationships with all departments that have direct or indirect impact on obtaining authorizations.
• Collaborate with other departments to obtain and analyze additional information; to record and process billing effectively.
• Daily monitoring of assigned queues for claim progression directly impacting timely payments, manages the claims process, including accurate and timely claim creation, follows-up and correspondence with required entities.
• Prepares and maintains an organized filing system for all program documents related to billing and analysis of authorization issues. Submit monthly reports of billing activities and developments to the CEO and Director.

• Reports summaries for authorization issues to senior leadership.
• Clearly document all contacts and authorization information for all types of authorizations and complete standardized documentation requirements in expected format. Follow established policies and procedures regarding authorization processes.
• Participate in training, regional meetings, staff retreats or other events required.
• Maintains a positive, life-giving environment for the members.
• Attends training and regular meetings.
• Attends weekly team meetings.
• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing with timely claim submission.
• Prepares and submits clean claims to third party payers either electronically or by paper per the payor guidelines.
• Maintains strictest confidentiality; adheres to all required guidelines/regulations.
• Contributes to every stage of revenue cycle, from claim submission to denial management, to payment posting review and reporting.
• Manages reports and complies with all permitting, licensing, security and certification.

MINIMUM QUALIFICATIONS

• High school diploma or equivalent.
• Proficiency in healthcare information systems, data management tools, various healthcare services, and/or related billing codes.
• Familiarity with DHCS/CalAIM guidelines and policies, including Medi-Cal, care coordination models, healthcare best practices, and cultural sensitivity.
• Strong interpersonal and communication skills on English (at minimum) for effective collaboration with population of focus, healthcare providers, and community organizations.
• Strong problem-solving skills and the ability to navigate difficult conversations with empathy and professionalism.
• Good organizational skills, ability to multitask, and effective assignment of priorities in a fast-paced environment.
• Ability to make informed decisions regarding authorization requests based on company policies and procedures.
• Willingness to foster strong relationships with other departments to maintain communication and support in handling authorization requests.
• Conduct periodic audits of authorization requests to ensure compliance and identify training needs.
• Proficiency in care assessment, planning, and implementation processes.
• Ability to utilize technology and data management systems effectively for case documentation and tracking.
• Willingness to foster partnerships with local agencies, institutions, or community organizations to enhance resource availability and support for Medi-Cal members.

PREFERRED QUALIFICATIONS

• Additional education or background in Health Administration, Social Services, Business, or a related field.
• Experience in fields such as healthcare authorization, customer ser

Job Type: Full-time