Billing Specialist (51389) at WestCare in Fresno, CA

Summary: WestCare is a nonprofit organization focused on social services, and they are seeking a Billing Specialist to ensure accurate and timely billing for CalAIM justice-involved pre-release services. The role involves verifying documentation, preparing billing submissions, and monitoring reimbursement while ensuring compliance with Medi-Cal and Managed Care Plan billing requirements.

Responsibilities:
- Review program documentation to ensure services meet CalAIM, Medi-Cal, and Managed Care Plan billing requirements
- Prepare and submit billing for CalAIM services, including Enhanced Care Management and applicable pre-release services
- Verify eligibility, enrollment, and service authorization requirements prior to billing submission
- Coordinate with program staff to ensure documentation supports billable services and meets required standards
- Monitor billing activity, track claims submissions, and follow up on denied or pending claims
- Work with Managed Care Plans to resolve billing discrepancies and reimbursement issues
- Maintain accurate billing records and ensure timely submission of claims
- Generate billing reports and provide updates to program leadership regarding billing status and reimbursement trends
- Support compliance with regulatory and contractual billing requirements
- Assist in the development and implementation of billing procedures related to CalAIM services
- Embrace and embody the mission, vision, guiding principles, clinical vision, and goals of WestCare Foundation
- Perform other duties as assigned

Required Qualifications:
- Strong attention to detail, organizational skills, and ability to manage multiple deadlines
- Valid driver's license and ability to obtain and maintain WestCare's vehicle insurance is required
- Ability to obtain and maintain successful background clearance
- 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
- CPR Certification, First Aid Certification, and an annual Tuberculosis test
- High school diploma or equivalent required

Preferred Qualifications:
- Experience with Medi-Cal, CalAIM, Enhanced Care Management, or healthcare billing preferred
- Knowledge of healthcare documentation and billing practices
- associate or bachelor's degree preferred

Required Skills: CalAIM billing, Medi-Cal billing, Managed Care Plan billing, Healthcare billing, Eligibility verification, Service authorization verification, Claims submission tracking, Billing discrepancy resolution, Billing report generation, CPR Certification, First Aid Certification, Tuberculosis testing