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About the Role
The CalAIM Billing & Accounts Receivable (AR) Specialist supports the organization's revenue cycle operations by ensuring accurate billing, timely claims processing, denial resolution, and effective accounts receivable management for CalAIM programs, including Enhanced Care Management (ECM) and Community Supports (CS). This role involves collaborating with various departments and external partners to submit claims, resolve reimbursement issues, and support cash collection.
Responsibilities
- Prepare, review, and submit accurate and timely claims to Medi-Cal Managed Care Plans (MCPs), commercial payers, and other applicable funding sources.
- Review billing documentation for completeness and accuracy, including eligibility, authorizations, dates of service, and payer-specific requirements.
- Monitor claim status and follow up on rejected, denied, unpaid, and underpaid claims through final resolution.
- Investigate denials and reimbursement issues and prepare corrected claims, resubmissions, appeals, reconsiderations, and retroactive authorization requests as appropriate.
- Perform charge entry, payment posting, contractual adjustments, and reconciliation of Electronic Remittance Advices (ERAs), Explanation of Benefits (EOBs), and payer payments.
- Monitor accounts receivable aging by payer and program and perform timely follow-up on outstanding balances.
- Maintain billing trackers, denial logs, AR reports, payer issue logs, and supporting documentation.
- Identify recurring billing, authorization, documentation, or reimbursement issues and escalate significant or systemic concerns to the CalAIM Revenue Cycle Manager.
- Work with Program Operations, clinical teams, and other internal partners to obtain missing documentation and resolve billing discrepancies.
- Communicate with MCPs and other payers regarding claim status, payment discrepancies, authorizations, denials, and billing requirements.
- Maintain accurate documentation within applicable EMR/EHR, billing, and accounting systems.
- Support monthly billing and AR reconciliations, including reconciling claims submitted, payments received, outstanding balances, and adjustments.
- Provide billing and AR information to support monthly revenue estimates, revenue recognition, month-end close, and financial reporting.
- Stay current on Medi-Cal, CalAIM, MCP requirements, payer policies, and applicable billing regulations.
- Assist with payer onboarding, new billing requirements, system updates, workflow improvements, and internal or external audits.
- Perform other duties and special projects as assigned.
Requirements
- Minimum of three (3) years of medical billing, healthcare claims, or accounts receivable follow-up experience in a healthcare setting.
- Demonstrated experience with Medi-Cal Managed Care, Medicaid, or commercial payer billing and claims processes.
- Experience preparing and submitting healthcare claims and following claims through final payment or resolution.
- Proven ability to investigate and resolve claim denials, prepare corrected claims and appeals, and address authorization-related billing issues.
- Experience with accounts receivable follow-up, payment posting, and reconciliation.
- Proficiency with EMR/EHR systems, billing software, payer portals, and Microsoft Excel, including sorting, filtering, and lookup functions.
- Strong analytical, organizational, problem-solving, and follow-up skills with excellent attention to detail.
- Ability to manage multiple payer deadlines and outstanding items independently while appropriately escalating complex issues.
- Excellent written and verbal communication skills and ability to collaborate effectively with Accounting, Program Operations, clinical teams, and external payers.
Skills
- Medi-Cal Managed Care
- Medicaid
- Commercial payer billing
- Claims processing
- Accounts receivable follow-up
- Payment posting
- Reconciliation
- EMR/EHR systems
- Billing software
- Payer portals
- Microsoft Excel
- Analytical skills
- Organizational skills
- Problem-solving skills
- Follow-up skills
- Attention to detail
- Communication skills
Location
- Hybrid
Work Type
- Hybrid
- Full-time
Experience Level
- Minimum of three (3) years of experience
Education Level
- Associate's or bachelor's degree in Healthcare Administration, Business Administration, Accounting, Finance, or a related field (Preferred)
Salary/Compensations
- $80,000 to $90,000/annual
About the Company
- IOA is on the forefront of revolutionary healthcare models, reshaping the way people can age in place.
- Our innovative models transform lives, enhance communities, and save healthcare systems millions of dollars.
- We strive to consistently question the “status-quo” and create new and more innovative ways to help aging adults and adults with disabilities maintain their quality of life.
- With over 23 programs, we offer multiple ways to aid seniors maintain their health, well-being, independence and participation in the community, fulfilling our mission.