Billing Specialist

Job OverviewThe Billing Specialist will review and verify that client records are complete for a successful transmission of medical claims for reimbursement from the Department of Mental Health and private third-party providers. The Billing Specialist is responsible for ensuring that information is processed accurately and timely, and is Familiar with concepts, practices, and procedures for all billing claims to the Department of Mental Health (DMH) using the Electronic Health Record (EHR) software EXYM.Essential Duties and Responsibilities (Included but not limited to):

• Submit timely weekly billing to Los Angeles County Department of Mental Health and third-party payers using EHR, EXYM and Office Ally.
• Collaborate with QA Department to oversee the electronic health record, EXYM; for billing, case closures, location, funding sources and productivity updates.
• Review, manage and develop billing procedures as needed to maintain compliance with local, state and federal regulations.
• Knowledge of use and application of Current Procedural Terminology (CPT) Codes.
• Identify and notify management of denial patterns and issues.
• Responsible for data tracking and reporting.
• Manage, track and resolve denied and voided claims, following through until claim is paid.
• Responsible for weekly download of SIFT Data. Review data for claim accuracy in DMH/IBHIS and EXYM systems.
• Collaborate and consult effectively with Clinical Quality Assurance, Mental Health and any other staff/programs to ensure adherence to policies and procedures.
• Generate and distribute statistical management reports to leadership, identifying unfiled, pending, denied, and submitted claims.
• Responsible for maintaining the highest level of billing standards following current guidelines from Medi-Cal, and other insurance entities.
• Understand how mental health staff in electronic databases (NAPPA, NPPES) affects billing accuracy and completion.
• Check Medi-Cal eligibility on a bi-monthly basis for all clients and compile list of clients with terminated Medi-Cal as needed and provide management reports.
• Attend internal and external meetings and training.
• Performs a variety of general clerical duties; prepares a variety of routine correspondence, forms, reports and similar items using word processing and Excel Spreadsheet.
• Develop and maintain claim resolution skills through continuous training, workshops and education.
• Other duties as assigned.

Education and Experience

• High school diploma or GED and a minimum of 3 years’ recent experience in Los Angeles Department of Mental Health (DMH) billing.
• Experience in Electronic Health Record EXYM preferred.
• Knowledge of and expertise in third party payers and Medi‐Cal billing.
• Computer skills with strong proficiency in Microsoft Office Software (Excel, Outlook and Word).
• Strong written and oral communication skills, presenting financial results to all relevant parties.
• Excellent data management skills.
• Able to be accurate, precise, and thorough and detail oriented.
• Ability to perform mathematical and data processing tasks rapidly and accurately.
• Demonstrates ability to handle multiple tasks simultaneously and to work independently.
• A self-starter, with the ability to coordinate multiple projects/tasks at once.
• Possess problem solving and conflict resolution skills and exercises professional judgement.
• Flexible, adaptable, and capable of working in a fast paced, professional environment.
• Maintain and execute confidential information using HIPAA standards.
• Covid-19 vaccinated and boosted or with a medical/religious exemption.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Noise Level: The noise level in the work environment is usually moderate.

Environment: Office

Work Hours: Usually standard business hours, but some evening and weekend hours, as needed.

Physical Demands

While performing the duties of this job, the employee is regularly required:

• Frequently sit, stand, walk, stop, kneel, and crouch, regularly talk and hear.
• Frequently use hands, and fingers to handle or feel.
• Occasionally lift or move up to 25 pounds.
• Specific vision abilities required include close vision, distance vision, color vision, and peripheral vision.
• Depth perception and the ability to adjust focus.
• Ability to drive surface streets and highways.

This description is intended to describe the general nature and level of work being performed. It is not an exhaustive list of duties, responsibilities, and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties and responsibilities at any time.

Job Type: Full-time

Pay: From $24.00 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday
• Weekends as needed

Work Location: In person

Salary : $24