Senior Medical Billing & EHR Specialist

Position Summary The Senior Medical Billing & EHR Specialist is responsible for supporting the implementation, maintenance, integrity, reporting, billing, and day-to-day operational functions of electronic health record (EHR) systems and CalAIM service administration related to Enhanced Care Management (ECM) and Community Supports (CS) programs.

This position serves as a liaison between program staff, leadership, billing personnel, Managed Care Plans (MCPs), software vendors, and technology support teams to ensure accurate documentation, workflow efficiency, claims processing, authorization management, compliance, reimbursement, and data reporting in alignment with Department of Health Care Services (DHCS), CalAIM, Medi-Cal, HIPAA, MCP, and organizational requirements.

The Specialist provides technical support and training to staff utilizing EHR systems, supports billing and claims management activities, assists with quality improvement initiatives, monitors program data and documentation integrity, and helps ensure compliance with all reporting and reimbursement requirements. This position reports to the Assistant Director of CalAIM Services.

• This is an In-Person position only*

Qualifications

Associate's degree in health information management, Medical Billing and Coding, Healthcare Administration, Information Technology, Business Administration or Public Health. Bachelors in business, IT, or comparable field is preferred Minimum of two years of experience working with electronic health records, healthcare data systems, medical billing, program reporting, or related healthcare administrative functions Experience supporting EHR workflows, training users, and troubleshooting technical issues preferred Knowledge of CalAIM, Enhanced Care Management (ECM), Community Supports (CS), Medi-Cal, and healthcare documentation standards preferred Experience with medical billing, claims processing, authorizations, denial management, and reimbursement workflows preferred Experience working in community-based healthcare, behavioral health, homelessness services, social services, or reentry programming preferred Familiarity with encounter data reporting, MCP requirements, DHCS documentation standards, and billing regulations Experience with care coordination platforms, billing software, reporting tools, and data dashboards Strong understanding of HIPAA, confidentiality, data integrity, and compliance standards Excellent organizational, analytical, communication, and problem-solving skills Ability to manage multiple priorities and work independently in a fast-paced environment

Essential Duties and Responsibilities EHR & Systems Support

Provide day-to-day support to ECM and Community Supports staff regarding EHR documentation, workflows, and system functionality Assist with implementation, maintenance, testing, optimization, and troubleshooting of EHR systems and related software platforms Coordinate with software vendors and IT support personnel to resolve technical issues Maintain working knowledge of applications, workflows, documentation systems, and reporting platforms utilized within CalAIM programming Support staff in proper use of electronic systems including assessments, care plans, progress notes, authorizations, encounter tracking, reporting tools, and billing-related documentation Participate in software upgrades, workflow enhancements, and system testing activities

Billing & Claims Management

Prepare, review, and submit claims and invoices to Managed Care Plans for ECM and Community Supports services Ensure claims are complete, accurate, compliant, and submitted in accordance with DHCS, Medi-Cal, and MCP requirements Utilize approved billing codes, claim specifications, and documentation standards applicable to CalAIM services Monitor billing queues, claim status, payment activity, and reimbursement trends Manage denials, corrections, appeals, resubmissions, and claim follow-up activities Process payment postings, reconcile payer responses, and maintain billing records Collaborate with program staff to ensure documentation supports claims submission and reimbursement requirements

Authorization & Eligibility Management

Verify member eligibility with assigned MCPs prior to billing and throughout service enrollment periods Monitor referrals, authorizations, service approvals, and reauthorization requirements Track authorization expiration dates and coordinate renewal activities with program staff Ensure services billed are authorized, documented, and compliant with payer requirements

Training & Workflow Support

Conduct training for care managers, housing support specialists, supervisors, and administrative staff on EHR documentation standards, workflows, billing requirements, and system functionality Provide onboarding and refresher training related to ECM and Community Supports documentation and billing expectations Assist staff in resolving documentation deficiencies that impact compliance, reporting, billing, or reimbursement Monitor workflow efficiency and recommend process improvements to enhance service delivery and operational effectiveness Develop and maintain user guides, workflow documentation, and training materials

Data Integrity & Compliance

Maintain system data integrity by ensuring accurate, timely, and complete documentation within EHR and billing systems Monitor documentation compliance with DHCS, MCP, HIPAA, Medi-Cal, and organizational standards Ensure proper storage and tracking of consent forms, releases of information, authorizations, and required service documentation Support encounter data submission requirements and reporting standards for ECM and Community Supports services Maintain confidentiality of protected health information in accordance with HIPAA and organizational policies Assist with audits, monitoring activities, and corrective action efforts related to documentation, billing, and compliance

Reporting & Performance Monitoring

Generate and maintain reports related to program performance, service utilization, member engagement, staffing capacity, claims activity, reimbursement trends, and compliance monitoring Assist leadership with quarterly reports, audits, implementation monitoring, quality assurance activities, and MCP reporting requirements Track key program and billing metrics and identify trends requiring corrective action or process improvement Monitor documentation timeliness and follow up regarding missing, incomplete, or non-compliant records Support continuous quality improvement initiatives through data analysis and reporting

Help Desk & Technical Support

Document, prioritize, research, and resolve internal support tickets and system-related issues Provide phone, remote, and in-person support to staff experiencing technical or workflow challenges Escalate unresolved software or technical issues to appropriate software vendors or IT personnel Maintain documentation of support requests, resolutions, workflow changes, and system updates