Billing Specialist

POSITION SUMMARY

Turns documented FSP-HFW services into accurate, timely Medi-Cal claims and County invoices, then follows each claim until it is paid. Billing Specialists enter billing data separately from the clinicians and direct service staff who provide and document the services. Turns documented FSP-HFW services into accurate, timely Medi-Cal claims and County invoices, then follows each claim until it is paid. Billing Specialists enter billing data separately from the clinicians and direct service staff who provide and document the services.

Essential Duties and Responsibilities

• When a referral comes in, obtain the IRIS referral documents and give them to the Intake Specialist: client history by MRN, Medi-Cal eligibility, Special Cohort status, and the current status of the CANS and PSC-35.
• Check Medi-Cal eligibility and other insurance at intake and every month. Flag clients whose coverage has lapsed or changed.
• Create the client intake profile in IRIS, including the Special Cohort designation when it applies.
• Enter CANS and PSC-35 results in IRIS.
• Update client demographics in IRIS whenever they change while the client is enrolled.
• Review services entered in the EHR for billing completeness (codes, units, dates, rendering provider NPI, location) before claims go out.
• Enter and submit claims through the County billing system (IRIS) and the 837 claim files.
• Work the denial and rejection queues: find the cause, send corrections back to staff when needed, and resubmit claims on time.
• Correct any service billed by mistake within 10 calendar days of finding it, as Exhibit A requires.
• Post payments and remittances (835s), reconcile them to submitted claims, and track accounts receivable by age.
• Help prepare the monthly County invoice, due on the 20th, along with its backup.
• Complete Coordination of Benefits before billing Medi-Cal.
• When a client leaves the program, discharge them in IRIS and close the episode of care (EOC) on time.
• Keep the rendering-provider list current: new hires' NPIs, credentials, and taxonomy. Report NPIs to the County as soon as staff receive them.
• Keep billing records in a form ready for audit and retention: claims, remittances, invoices, and supporting time records.
• Use only the IRIS token assigned to you, and return it when you leave or no longer need access.

Minimum Qualifications

• High school diploma or equivalent required. An associate degree or a medical billing certificate is preferred.
• At least 2 years of healthcare claims billing, preferably Medi-Cal or County behavioral health (SMHS).
• Familiarity with CPT and HCPCS codes, CMS-1500 and 837P claims, eligibility verification, and reading 835 remittances.
• Strong attention to detail, intermediate Excel skills, and experience working in an EHR, with myEvolv (Netsmart) experience strongly preferred.

Preferred Qualifications

• CPB or CMRS certification.
• Experience with Orange County HCA's IRIS system.
• Bilingual (English/Spanish or English/Vietnamese) for eligibility follow-up with families.

Required Trainings

County BHS New User Training (required for anyone who enters data in the County billing system), Annual Provider Training, Annual Compliance Training, and HIPAA/42 CFR Part 2 training.

PHYSICAL REQUIREMENTS:

• Ability to drive a motor vehicle without restrictions, often in heavy traffic and frequently long distances (one hour or more).
• Senses of vision, hearing and smell sufficient to regularly operate a motor vehicle, to visualize threats in the environment and operate safely. 
• Required to occasionally lift and carry 10-20 pounds.
• Regularly required to sit, stand, climb stairs (1 or more flights) and walk. 
• Regularly required to sit and use computer in office settings.

EOE, INCLUDING DISABILITY/VETS

We are an equal opportunity employer and consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, disability, medical condition, genetic information, marital status, veteran status, or any other protected characteristic under California law.

Management reserves the right to add, change, delete or rescind duties or responsibilities of positions within the job classification at any time.