Billing Specialist

Billing Specialist

Job Details

Job Location

Fresno - 1900 N Gateway - Fresno, CA

Position Type

Full Time

Education Level

High School

Salary Range

$24.00 - $24.00 Hourly

Job Category

Admin - Clerical

Description

POSITION SUMMARY :

This position is responsible for preparing, submitting, and reconciling billing data for services provided under CalAIM, including DMC-ODS, Enhanced Care Management (ECM), and Community Supports. This position ensures claims are submitted accurately and timely directly to insurance carriers and Medi-Cal Managed Care Plans (MCPs) in accordance with all DHCS, payer, and organizational guidelines. The specialist works closely with fiscal, clinical, and data teams to ensure service documentation meets billing standards, resolve denials, and maintain the integrity of client and program data across systems.

Essential Job Functions include those listed below.

ESSENTIAL JOB FUNCTIONS :

Prepare, submit and track CalAIM claims directly to Medi-Cal Managed Care Plans and insurance carriers.

Verify client eligibility, authorizations, and service coverage using payer portals and eligibility systems.

Review clinical documentation to ensure completeness, accuracy, and compliance before billing.

Apply correct procedure codes (CPT / HCPCS), modifiers, and units in line with CalAIM billing.

Reconcile payments and denials; research and correct claim errors or rejections in coordination with fiscal and program staff.

Maintain and update billing records, logs, and spreadsheets to ensure data accuracy and audit readiness.

Generate billing, payment, and denial reports for management review.

Monitor claim timeliness, submission deadlines, and reimbursement trends.

Communicate with Managed Care Plan representatives as needed to resolve claim or authorization issues.

Support internal and external audits, ensuring documentation and claims meet DHCS and payer compliance standards.

Maintain strict confidentiality of all client and financial data in accordance with HIPAA.

Must Embrace and embody the mission, vision, guiding principles, clinical vision, and goals of WestCare Foundation; and

Perform all other duties as assigned.

Qualifications

ESSENTIAL QUALIFICATIONS :

To perform this job successfully, an individual must be able to perform the duties and responsibilities satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required.

Experience and Competencies :

Working knowledge of Medi-Cal billing regulations, DHCS documentation standards, and payer requirements.

Proficient in billing software, electronic health records (EHR), and Microsoft Excel for data tracking and reconciliation.

Strong attention to detail, accuracy, and organization in managing billing and documentation workflows.

Ability to analyze claim denials, research issues, and implement corrective actions.

Effective verbal and written communication skills to coordinate with internal departments and payer representatives.

Ability to handle sensitive and confidential information in compliance with HIPAA and organizational policies.

Capable of working independently and collaboratively in a fast-paced, deadline-driven environment.

Adherence to the highest standard of ethical conduct, especially to standards governing confidentiality.

Professional appearance and demeanor.

CPR Certification, First Aid Certification, and an annual Tuberculosis test.

Ability to obtain and maintain a criminal history background check.

Must be able to obtain and maintain eligibility for WestCare’s Vehicle Insurance.

During your tenure with WestCare there may be new requirements, including, but not limited to vaccinations that are issued by local, State, Federal, and / or Funders that WestCare may have to comply with. Should this occur Human Resources or appropriate personnel will inform you.

EDUCATION and / or EXPERIENCE :

Minimum of 2 years of billing experience in a behavioral health, medical, or managed care setting.

Experience with Medi-Cal, DMC-ODS, or CalAIM billing preferred.

Knowledge of CPT / HCPCS codes, modifiers, and claims reconciliation processes.

High school diploma or equivalent required; associate degree in business, accounting, health administration, or related field preferred.

LICENSURE / CERTIFICATION :

• Not applicable for this position.

WORKING CONDITIONS :

Work is primarily performed in an office setting.

Some travel is required; and

Some outdoor activities may be required.