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 Health Home (IHH) is a growing non-profit 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. IHH currently has 13 facilities with 22 micro-communities 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 addition the Claims Specialist is also responsible for keeping up to date accounts receivable for both CalAIM claim follow-up and must have knowledge of billing codes and standard procedures.
The pay range for this position is $25.00 - $27.00 per hour depending on experience. After successful completion of 90-day probation period this position will be eligible for Hybrid schedule with 2days in office (Wed/Fri) and 3days working from home (Mon/Tues/Thurs).
Responsibilities
Attend monthly team meetings or trainings at Corporate location
Reviewing data and creating Claims for services rendered
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
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 (Escalations/Appeals/Claim corrections)
Monitor and maintain county aging and escalating trends write offs etc.
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
Preferred Experience/Minimum Qualifications
Required:
- High School Diploma or equivalent.
- 1-2 years relevant experience.
- Basic computer skills including the ability to send and receive emails and summarize data in spreadsheets.
- Valid CA Drivers License and eligibility for company vehicle insurance.
- Prior experience work in Electronic Billing Platforms and EHR systems
- Prior experience working with claims and communication with health networks
Preferred:
- Proficiency in Microsoft (Outlook Word Excel Teams).
- Associates Degreeor higher
- Experience in Medical Billing and Primary Care Billing
- Medical Billing Certification
Benefits
- Hybrid schedule with 2days in office and 3days working from home (After successful completion of 90-day probation period)
- 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
- 10days vacation PTO/year
- 6 days sick PTO/year
- 10 days holiday PTO/year
- Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans
Required Experience:
Manager
Employment Type
Full-Time
