Claims Specialist

Illumination Health + HomeRiverside, CA, US

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Job Description

Every person deserves compassion, dignity, and the safety of a place to call home.”

Homelessness is the largest social and public health crisis in California. Illumination Health + Home (IH+H) is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care centers, emergency shelters, housing services and children's and family programs. IH+H currently has 13+ facilities with 22+ micro-communities scattered across Orange County, Los Angeles County and the Inland Empire.

Job Description

The Claims Specialist is responsible for accuracy of claims submission, benefits and eligibility verification, accuracy of client information. In addition, the Claims Specialist is also responsible for keeping up to date accounts receivable for both CalAIM, claim follow-up, and must have knowledge of billing codes and standard procedures.

The pay range for this position is $25.00 - $27.00 per hour, depending on experience. After successful completion of 90-day probation period, this position will be eligible for Hybrid schedule with 2 days in office (Wed / Fri) and 3 days working from home (Mon / Tues / Thurs).

Responsibilities

CalAIM Billing and Follow up :

Attend monthly team meetings or trainings at Corporate location
Reviewing data and creating Claims for services rendered
Ensure claims meet the standards of our contracts and programs.
Verifying authorizations via provider portals or authorization letters on Kipu prior to claim submission.
Verifying eligibility prior to claim submission via provider or DHCS portals
Review client records to extract applicable data necessary for billing purposes, including but limited to ICD 10 Diagnosis codes, CPT codes for services rendered etc.
Review and follow up on outstanding unpaid claims
Review any rejected or denied claims and conduct proper follow up procedures (Escalations / Appeals / Claim corrections)
Monitor and maintain county aging and escalating trends, write offs, etc.
Have knowledge in understanding, reading EOB’s and Remittance Advice
Posting payment accurately to claims and continuing with the claim close out process
Assist supervisors in any projects related to billing that may come up

Preferred Experience / Minimum Qualifications

Required :

High School Diploma or equivalent.

1-2 years' relevant experience.

Basic computer skills, including the ability to send and receive emails and summarize data in spreadsheets.

Valid CA Driver’s License and eligibility for company vehicle insurance.

Prior experience work in Electronic Billing Platforms and EHR systems

Prior experience working with claims and communication with health networks

Preferred :

Proficiency in Microsoft (Outlook, Word, Excel, Teams).

Associate’s Degree or higher

Experience in Medical Billing and Primary Care Billing

Medical Billing Certification

Benefits

Hybrid schedule with 2 days in office and 3 days working from home (After successful completion of 90-day probation period)

Medical Insurance funded up to 91% by Illumination Foundation (Kaiser and Blue Shield), depending on the plan

Dental and Vision Insurance

Life, AD&D and LTD Insurance funded 100% by Illumination Foundation

Employee Assistance Program

Professional Development Reimbursement

401K with Company Matching

10 days vacation PTO / year

6 days sick PTO / year

10 days holiday PTO / year

Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans

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Claim Specialist • Riverside, CA, US