Responsible for front-end claiming activities across various clinical programs. Opens clients in the Electronic Health Records (EHR) systems and other contract billing systems and ensures appropriate billing documentation is accurate, timely, and when applicable, on file. Monitors and updates information and data in the EHR for all active clients. Verifies benefit eligibility and supports claiming activities.
- Verifies benefit eligibility.
- Enrolls clients and enters information into the EHR system to support claiming activities.
- Monitors and updates information and data in the EHR for all active clients such as transfers, benefit assignments, change in benefit assignments, and change in location of services.
- Maintains documentation and appropriate verification of clients’ benefit eligibility, (MediCal, other health coverage, etc.).
- Works collaboratively with Family Engagement Navigators, Quality Assurance Coordinators, and Health Information Management (HIM) Specialists.
- Maintains extensive knowledge of claims status rule sets to assure claims are sent to County, State and other funders for processing and payment.
- Attends trainings sponsored by funding sources.
- Produces claiming system-specific reports to monitor accuracy of data entry to minimize billing issues and make necessary corrections.
- Participates in internal and external audit processes and supports audit preparation: pulling, organizing, reviewing, and providing other support to Quality Assurance.
This Position Requires:
- Two years of billing or claims processing experience.
- High school diploma or general education degree (GED) required.
- Associate's degree or equivalent in general education from a two-year college or technical school preferred.
- Travel to all service areas up to 25% & Driver's licensed required
- Excel experience required
- DMH Regulations experience required
- EDI billing experienced highly preferred
- Experience working in EXYM highly preferred
- PRM application through DMH highly preferred
- EDI Billing: 1 year (Preferred)
- EXYM: 1 year (Preferred)
- Excel: 1 year (Required)
- DMH Regulations: 1 year (Required)
- Billing or Claims: 2 years (Required)
- PRM Application through DMH: 1 year (Preferred)
- 25% Travel (Required)
- Paid time off
- Health insurance
- Dental insurance
- Healthcare spending or reimbursement accounts such as HSAs or FSAs
- Other types of insurance
- Retirement benefits or accounts
- Education assistance or tuition reimbursement
- Gym memberships or discounts
- Employee discounts
- Flexible schedules
Children’s Institute, Inc. does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations.