Accounts Receivable, Billing, Cash Flow, Detail Oriented, Documentation, Electronic Medical Records, Engineering Change Management, Health Plan, Healthcare, Home Care, Keyboards, MCP - Microsoft Certified Professional, Managed Care, Medi-Cal, Medical Billing, Medical Record System, Microsoft Excel, Patient Care Denials, Payment Posting, Physical Demands, Problem Solving Skills, Reimbursement, Retro, Time Management, Trend Analysis
JOB DESCRIPTION
Position: CalAIM Billing & Accounts Receivable (AR) Specialist
Pay Range: $27.00-$29.00 PER HR
Reporting To: Reimbursement Manager
Work Type: On-Site
POSITION SUMMARY:
The CalAIM Billing & Accounts Receivable (AR) Specialist is responsible for supporting the revenue cycle through accurate billing, claims follow-up, denial management, and accounts receivable resolution. This role requires hands-on experience with CalAIM and Medi-Cal managed care, with a focus on submitting clean claims, resolving billing issues promptly, and helping maintain consistent cash flow.
REQUIRED QUALIFICATIONS:
- 3+ years of medical billing/AR follow up experience in a healthcare setting.
- Proven proficiency with Medi Cal managed care and commercial payers’ claim workflows.
- Track record resolving denials, submitting appeals, and obtaining/correcting authorizations.
- Proficiency with EMR/EHR and billing systems; strong Excel skills (filters, sorting, lookups).
- Exceptional attention to detail, organization, and written communication.
PREFERRED QUALIFICATIONS:
- Direct CalAIM experience (for example, ECM/CS or other CalAIM benefits), MCP portal submissions, and authorization management preferred.
- Home health or community-based services billing experience preferred.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
The following statements are intended to describe the general nature and level of work performed in this role. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position.
- Prepare, review, and submit clean claims to Medi-Cal, commercial payers, and managed care plans.
- Submit and track claims to MCPs; verify authorizations; resolve denials related to medical necessity, prior authorizations, referrals, and program eligibility; and prepare professional appeal letters and retro-authorization requests when applicable.
- Perform accurate charge entry, payment posting, and adjustments; reconcile remittances (ERA/EOBs); and maintain precise documentation in EMR and billing systems.
- Monitor accounts receivable aging by payer and program, identify denial trends, and escalate root causes with clear and actionable summaries.
- Respond to billing inquiries from patients, providers, and MCPs in a professional, accurate, and timely manner.
PHYSICAL REQUIREMENTS:
- Stand, sit, talk, hear, reach, stoop, kneel and use of hands and fingers to operate computer, telephone, and keyboard on a frequent basis (up to 75% of the time).
- Close vision requirements due to computer work.
- Light to moderate lifting may be required (up to 25lbs).