Medical Claims Specialist

We are a small, mission-driven, family-owned business dedicated to helping California’s seniors transition from Medicaid-funded nursing homes into personalized, community-based assisted living settings. We focus on high-touch support ensuring every family and care home feels supported and heard.

As a Community Support Provider for Managed Care Plans contracted under the California Advancing and Innovating Medi-Cal (CalAIM) program, you will advocate for the elderly by managing authorizations and billing and providing compassionate customer service to families and care homes.

Work hours are 12:00 PM – 8:00 PM EST (fixed to align with 9:00 AM – 5:00 PM PST California business hours). The applicant must reside in Florida for tax purposes.

Responsibilities include:

• Submit, track, and secure authorization requests from Managed Care Plans.
• Prepare and submit Medicaid (Medi-Cal) claims accurately and timely.
• Provide responsive support to families and assisted living homes regarding authorizations, billing, and reimbursements.
• Communicate effectively in English and Spanish.
• Coordinate reimbursements from Managed Care Plans to Residential Care Facilities for the Elderly.
• Research and resolve denied authorizations or billing discrepancies proactively.

Qualifications:

• Minimum Associate’s Degree.
• At least 1 year Medicaid/medical billing experience, including authorization requests.
• Bilingual in Spanish and English (verbal and written).
• Proficient in Microsoft Excel and CRM/contact management software.
• Reliable computer, high-speed internet, and professional home-office space required.

Compensation & Benefits:

• Salary: $42,000 per year.
• Paid time off for vacation and sick leave.
• 401K available after sufficient work hours.
• Supportive, family-owned work environment.
• Health insurance is not provided.