CalAIM Billing & Accounts Receivable (AR) Specialist

JOB DESCRIPTION

Position: CalAIM Billing & Accounts Receivable (AR) Specialist

Pay Range: $27.00-$29.00 PER HR

Reporting To: Reimbursement Manager

Work Type: On-Site

POSITION SUMMARY:

The CalAIM Billing & Accounts Receivable (AR) Specialist is responsible for supporting the revenue cycle through accurate billing claims follow-up denial management and accounts receivable resolution. This role requires hands-on experience with CalAIM and Medi-Cal managed care with a focus on submitting clean claims resolving billing issues promptly and helping maintain consistent cash flow.

REQUIRED QUALIFICATIONS:

1. 3 years of medical billing/AR follow up experience in a healthcare setting.
2. Proven proficiency with Medi Cal managed care and commercial payers claim workflows.
3. Track record resolving denials submitting appeals and obtaining/correcting authorizations.
4. Proficiency with EMR/EHR and billing systems; strong Excel skills (filters sorting lookups).
5. Exceptional attention to detail organization and written communication.

PREFERRED QUALIFICATIONS:

1. Direct CalAIM experience (for example ECM/CS or other CalAIM benefits) MCP portal submissions and authorization management preferred.
2. Home health or community-based services billing experience preferred.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The following statements are intended to describe the general nature and level of work performed in this role. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position.

1. Prepare review and submit clean claims to Medi-Cal commercial payers and managed care plans.
2. Submit and track claims to MCPs; verify authorizations; resolve denials related to medical necessity prior authorizations referrals and program eligibility; and prepare professional appeal letters and retro-authorization requests when applicable.
3. Perform accurate charge entry payment posting and adjustments; reconcile remittances (ERA/EOBs); and maintain precise documentation in EMR and billing systems.
4. Monitor accounts receivable aging by payer and program identify denial trends and escalate root causes with clear and actionable summaries.
5. Respond to billing inquiries from patients providers and MCPs in a professional accurate and timely manner.

PHYSICAL REQUIREMENTS:

• Stand sit talk hear reach stoop kneel and use of hands and fingers to operate computer telephone and keyboard on a frequent basis (up to 75% of the time).
• Close vision requirements due to computer work.
• Light to moderate lifting may be required (up to 25lbs).