Billing & Claims Specialist - Medi-Cal CalAim Program

About Omatochi:

Omatochi is a leading home care service provider dedicated to enhancing the quality of life for our clients. We specialize in delivering compassionate and high-quality care with a focus on personalized solutions. As we continue to grow, we are seeking a skilled Billing Specialist to join our team and contribute to the success of our Medi-Cal CalAIM program.

Job Overview:

The Billing Specialist will play a pivotal role in the accurate and timely processing of billing and claims related to the Medi-Cal CalAIM program. This position requires a detail-oriented individual with a strong understanding of Medi-Cal billing procedures, specifically in the context of the CalAIM initiative. The ideal candidate will have experience navigating the complexities of Medi-Cal reimbursement and ensuring compliance with program regulations.

Responsibilities:

Claims Processing:

• Accurately prepare and submit claims for services rendered to Medi-Cal CalAIM, ensuring compliance with program guidelines and regulations.
• Review and verify the completeness of claims documentation, resolving any discrepancies or issues promptly.
  
  
  

Billing and Reimbursement:

• Collaborate with internal teams to gather necessary information for billing purposes.
• Monitor reimbursement activities, identifying and addressing any billing errors or discrepancies.
  
  
  

Program Compliance:

• Stay updated on changes to the Medi-Cal CalAIM program regulations, policies, and billing procedures.
• Ensure strict adherence to program requirements and maintain compliance with all relevant guidelines.
  
  
  

Documentation and Record-Keeping:

• Maintain accurate and organized records of billing transactions, claims submissions, and related documentation.
• Prepare reports and summaries as required for internal and external audits.
  
  
  

Communication and Collaboration:

• Communicate effectively with internal stakeholders, including care managers and administrative staff, to address billing-related inquiries and resolve issues.
• Collaborate with external entities, including Medi-Cal representatives and regulatory bodies, to facilitate smooth billing processes.
  
  
  

Qualifications:

• Bachelor's degree in Healthcare Management, Business Administration, or a related field.
• Minimum of 3 years of experience in billing and claims processing, with a focus on Medi-Cal programs.
• In-depth knowledge of the Medi-Cal CalAIM program regulations, guidelines, and billing procedures.
• Proficiency in using billing software and electronic health record (EHR) systems.
• Strong attention to detail and accuracy in claims submission and documentation.
• Excellent communication skills and the ability to collaborate effectively with cross-functional teams.
• Familiarity with relevant laws and regulations governing healthcare billing practices.
  
  
  

What We Offer:

• Competitive salary commensurate with experience.
• Comprehensive benefits package, including health insurance plans.
• Opportunities for professional development and career advancement.
• A supportive and inclusive work environment.
  
  
  

Omatochi is an equal opportunity employer. We encourage candidates of all backgrounds to apply.