CalAIM Billing & Accounts Receivable Specialist

Internal Employees: If you currently work at IOA please submit your application through the Internal Careers Page.

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. Rather than focusing on archaic outdated design we strive to consistently question the status-quo and create new and more innovative ways to help aging adults and adults with disabilities maintain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.

The CalAIM Billing & Accounts Receivable (AR) Specialist supports the organizations revenue cycle operations within the Accounting department by ensuring accurate billing timely claims processing denial resolution and effective accounts receivable management.

Reporting to the CalAIM Revenue Cycle Manager this position is responsible for the day-to-day execution and follow-up of billing activities for CalAIM programs including Enhanced Care Management (ECM) and Community Supports (CS). The Specialist works closely with Accounting Program Operations and Managed Care Plans (MCPs) to submit clean claims resolve reimbursement issues reconcile payments and support timely cash collection.

Work Arrangement: This is a hybrid position requiring a minimum of three (3) days per week on-site with remote work available on designated days subject to departmental and organizational needs.

Essential Duties & Responsibilities

The following statements describe the primary responsibilities of this position and are not intended to be an exhaustive list of all duties.

• 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.

Required Qualifications

• 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.

Preferred Qualifications & Education

• Associates or bachelors degree in Healthcare Administration Business Administration Accounting Finance or a related field.
• Direct experience with CalAIM programs including Enhanced Care Management (ECM) and Community Supports (CS).
• Experience working with multiple Medi-Cal Managed Care Plans payer portals authorization management and payer-specific billing requirements.
• Previous billing experience in home health community-based services behavioral health care management or value-based care programs.
• Working knowledge of healthcare documentation standards payer reimbursement methodologies revenue cycle processes and billing compliance.
• Experience supporting billing reconciliations month-end close or accounting-related revenue cycle activities.

COMPENSATION:

Range: $80000 to $90000/annual

This amount is not necessarily reflective of actual compensation that may be earned nor a promise of any specific pay for any specific employee which is always dependent on actual experience education and other factors.

This range does not include any additional equity benefits or other non-monetary compensation which may be included.

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