Claims Specialist
Claims Specialist
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Job Description
Every person deserves compassion dignity and the safety of a place to call home.
Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing nonprofit organization dedicated towards disrupting the cycle of homelessness by providing targeted interdisciplinary services in our recuperative care centers emergency shelters housing services and childrens and family programs. IF currently has 13 facilities with 22 microcommunities scattered across Orange County Los Angeles County and the Inland Empire.
Job Description
The Claims Specialist is responsible for accuracy of claims submission benefits and eligibility verification accuracy of client information. In addition the Claims specialist is also responsible for keeping up to date accounts receivable for both CalAIM claim followup and must have knowledge of Billing codes.
The pay rate for this role is$26$28 per hour.
The schedule for this role is a hybrid schedule withTuesday/Friday in office and Monday/Wednesday/Thursday WFH. 8:00am 4:30pm.
Responsibilities:
CalAIM Billing and Follow up
Ensure claims meet the standards of our contracts and programs.
Verifying authorizations via provider portals or authorization letters on Kipu prior to claim submission.
Verifying eligibility prior to claim submission via provider or DHCS portals.
Reviewing data and creating Claims for services rendered
Review client records to extract applicable data necessary for billing purposes including but limited to ICD 10 Diagnosis codes CPT codes for services rendered etc.
Review and follow up on outstanding unpaid claims.
Review any rejected or denied claims and conduct proper follow up procedures.
Have knowledge in understanding reading EOBs and Remittance Advice
Posting payment accurately to claims and continuing with the claim close out process.
Assist supervisors in any projects related to billing that may come up.
Communicate with tact and professionalism
Be able to meet targets and work under pressure with a high volume of claims
Maintain knowledge of industry standard CMS guidelines for Billing
Must be motivated to work independently as well as in a group setting.
- Fulfill Illumination Foundations Guiding Principles of Integrity Humility Sustainable Compassion Quest for Knowledge and Critical Thinking ClientCentered Care Innovation Advocacy and Stewardship and Compliance.
Minimum Qualifications/Preferred Experience:
High School Diploma or equivalent.
12 years relevant experience.
Basic computer skills including the ability to send and receive emails and summarize data in spreadsheets.
Prior experience work in Electronic Billing Platforms and EHR systems
Prior experience working with claims and communication with health networks
Proficiency in Microsoft (Mail Docs Sheets Calendar).
Associates degree or higher
Medical Billing Certificate
- Experience in Medical Billing and Primary Care Billing
Benefits
- Medical Insurance funded up to 91 by Illumination Foundation (Kaiser and Blue Shield) depending on the plan
- Dental and Vision Insurance
- Life AD&D and LTD Insurance funded 100 by Illumination Foundation
- Employee Assistance Program
- Professional Development Reimbursement
- 401K with Company Matching
- 10 days holiday PTO/year
- Paid vacation and sick days
- Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans
Required Experience:
Senior IC
Employment Type
Full-Time
