Turns documented FSP-HFW services into accurate, timely Medi-Cal claims and County invoices, then follows each claim through payment.
Responsibilities include:
- Obtain IRIS referral documents and provide them to the Intake Specialist, including client history by MRN, Medi-Cal eligibility, Special Cohort status, and CANS/PSC-35 status
- Check Medi-Cal eligibility and other insurance at intake and monthly
- Create and maintain client intake profiles in IRIS
- Enter CANS and PSC-35 results in IRIS
- Update client demographics as needed
- Review EHR services for billing completeness before claims are submitted
- Enter and submit claims through IRIS and 837 claim files
- Work denial and rejection queues and resubmit corrected claims
- Correct billing errors within required timelines
- Post payments and remittances, reconcile claims, and track accounts receivable aging
- Prepare monthly County invoices and supporting documentation
- Complete coordination of benefits before Medi-Cal billing
- Discharge clients in IRIS and close episodes of care on time
- Maintain rendering-provider NPI, credential, and taxonomy records
- Keep billing records audit-ready and follow token/access requirements
Requirements & Qualifications
Minimum qualifications:
- High school diploma or equivalent required
- Associate degree or medical billing certificate preferred
- At least 2 years of healthcare claims billing experience, preferably Medi-Cal or County behavioral health
- Familiarity with CPT and HCPCS codes, CMS-1500 and 837P claims, eligibility verification, and 835 remittances
- Strong attention to detail
- Intermediate Excel skills
- Experience working in an EHR
- myEvolv (Netsmart) experience strongly preferred
Preferred qualifications:
- CPB or CMRS certification
- Experience with Orange County HCA's IRIS system
- Bilingual English/Spanish or English/Vietnamese preferred
Required trainings:
- County BHS New User Training
- Annual Provider Training
- Annual Compliance Training
- HIPAA / 42 CFR Part 2 training
Benefits & Perks
Benefits include:
- Competitive compensation
- Paid time off
- Paid holidays
- Medical insurance
- Dental insurance
- Opportunity for advancement
Location
California, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago
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