Billing Specialist

Title: Billing Specialist
Report to: Senior Grants Billing Manager
Department: Administration
Hours: Monday-Friday, 8:30am -5:00pm
Location: Arlington Administration, 2116 Arlington Ave., Suite 100, Los Angeles, CA 90018
Status: Full-Time, Non-Exempt (Hourly); Non-Management
Benefits: Medical, Dental, Vision, Retirement Planning (403b), Employee Assistance Program (EAP), etc.

SUMMARY:
The Billing Specialist will review and verify through the use of reports that client records are complete for a successful transmission of medical claims for reimbursement from the Department of Mental Health and private third-party providers. The Billing Specialist is responsible for ensuring that information is processed accurately and timely, and is Familiar with concepts, practices, and procedures for all billing claims to Department of Mental Health (DMH) using the Electronic Health Record (EHR) software EXYM.

DUTIES and RESPONSIBILITIES:
1. Submit timely weekly billing to Los Angeles County Department of Mental Health and third-party payers using EHR, EXYM and Office Ally.
2. Collaborate with Sr. Billing Specialist and the QA Department to oversee the electronic health record, EXYM, for billing, case closures, location, funding sources and productivity updates.
3. Knowledge of use and application of Current Procedural Terminology (CPT) Codes.
4. Identify and notify management of denial patterns and issues.
5. Create and analyze data tracking reports.
6. Assist Sr. Billing Specialist to help manage, track and resolve claims (ie. denied claims, voided claims, submitted etc.) until claim is paid.
7. Responsible for weekly download of SIFT Data. Coordinate Senior Billing Specialist Review data for claim accuracy in DMH/IBHIS and EXYM systems.
8. Support the Sr. Billing Specialist and Clinical Quality Assurance, Mental Health and any other staff/ programs to ensure adherence to policies and procedures.
9. Assist with generating and distributing statistical management reports to leadership.
10. Responsible for maintaining the highest level of billing standards following current guidelines from Medi-Cal, and other insurance entities.
11. Understand how mental health staff in electronic databases (NAPPA, NPPES) affect billing accuracy and completion.
12. Check Medi-Cal eligibility on a bi-monthly basis for all clients and compile a list of clients with terminated Medi-Cal as needed and provide management reports.
13. Attend internal and external meetings and trainings.
14. Perform a variety of general clerical duties; prepare a variety of routine correspondence, forms, reports and similar items using word processing and Excel Spreadsheet.
15. Develop and maintain claim resolution skills through continuous trainings, workshops and education.
16. Assist with other billing functions as needed, i.e. assisting with back-up documentation and data entry.
17. Other duties as assigned.

QUALIFICATIONS:
1. High school diploma or GED and a minimum of 1-2 years' recent experience in medical billing.
2. Experience in Electronic Health Record, EXYM preferred.
3. Knowledge of and expertise in third party payers and Medi-Cal billing.
4. Computer skills with intermediate proficiency in Microsoft Office Software (Excel, Outlook and Word).
5. Strong written and oral communication skills, presenting financial results to all relevant parties.
6. Proficient data management and analysis skills.
7. Able to be accurate, precise, thorough and detail oriented.
8. Ability to perform mathematical and data processing tasks rapidly and accurately.
9. Demonstrates ability to handle multiple tasks simultaneously and to work independently.
10. A self-starter, with the ability to coordinate multiple projects/tasks at once.
11. Possess problem solving and conflict resolution skills and exercises professional judgement.
12. Flexible, adaptable, and capable of working in a fast paced, professional environment.
13. Maintain and execute confidential information using HIPAA standards.
14. Covid-19 vaccinated and boosted or with a medical/religious exemption.

PREFERRED QUALIFICATIONS:
1. Experience in Electronic Health Record, EXYM preferred.
2. Minimum of 1-2 years' recent experience in medical billing.
3. Intermediate proficiency in Microsoft Office Software (Excel, Outlook, and Word).
4. Some experience with the Department of Mental Health Medical Billing.

WORK ENVIRONMENT:
1. Primarily indoor office and congregate living facility environment.
2. Regularly required to sit, stand, bend and occasionally lift or carry up to 35-pounds.
3. May necessitate working in busy and loud environments.
4. May be exposed to elements like cold, heat, dust, noise, and odor.
5. May need to bend, stoop, twist, and sit throughout the day.