Job Details

Pay: $21.00 - $25.91 per hour

Job description

The Medi-Cal Specialist is responsible for the accurate and timely billing, follow-up, and collection of claims to government payors and/or secondary insurers. This role involves managing the full billing cycle, including resolving denials, addressing billing inquiries, reviewing patient accounts, and ensuring timely claim submission and resolution. The ideal candidate will maintain accounts receivable aging under 120 days, maximize cash flow, and be well-versed in regulatory requirements, electronic and paper billing, and UB04 billing formats.

Qualifications

• 2 years of recent Medi-Cal Billing experience - Acute Care Hospital
• Knowledge of medical terminology
• Understand UB04 claim form, CPT, HCPCS, ICD-9, and ICD-10 Codes

Responsibilities

• Accurately bill Inpatient Acute and Outpatient services, including crossover claims (Primary/Secondary).
• Ensure all inpatient claims have the appropriate TAR per Medi-Cal requirements.
• Gather and update necessary documentation for billing and claims processing in compliance with Medi-Cal policies.
• Proactively follow up on claims to ensure resolution within 120 days and maintain aging accounts.
• Monitor remittances (EOBs/ERAs) to ensure accurate payments and proper adjudication.
• Review and resolve denials, rejections, and turnaround documents in a timely manner.
• Submit secondary claims, late charges, and credits as necessary.
• Analyze accounts for potential refunds or invoice discrepancies.
• Verify patient insurance benefits and calculate expected reimbursements.
• Appeal underpaid or denied claims with appropriate documentation.
• Maintain current billing and expedite payments through timely follow-ups.
• Submit clean claims with all required documentation for processing.
• Keep up to date with changes to Medi-Cal billing rules and coding regulations.
• Respond to insurance correspondence and resolve billing issues independently.
• Assist in tracking and posting payments.
• Work daily mail and credit balance reports.

Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for CHLB roles, including but not limited to shift differential and other special pay practices, etc. The posted compensation for the position is a reasonable estimate that extends from the lowest to the highest pay that CHLB in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.

Job Type: Full-time

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Work Location: In person