Claims Specialist

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 Foundation (IF) 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. IF 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. 

The pay rate for this role is $26-$28 per hour. 
The schedule for this role is a hybrid schedule with Tuesday/Friday in office and Monday/Wednesday/Thursday WFH. 8:00am - 4:30pm. 

Responsibilities: 

CalAIM Billing and Follow up 

• 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. 

• Reviewing data and creating Claims for services rendered 

• 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. 

• 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. 

• Communicate with tact and professionalism 

• Be able to meet targets and work under pressure with a high volume of claims 

• Maintain knowledge of industry standard CMS guidelines for Billing  

• Must be motivated to work independently as well as in a group setting. 

• Fulfill Illumination Foundation’s Guiding Principles of Integrity, Humility, Sustainable Compassion, Quest for Knowledge and Critical Thinking, Client-Centered Care, Innovation, Advocacy, and Stewardship and Compliance.  

Minimum Qualifications/Preferred Experience:
 

• 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.  

• Prior experience work in Electronic Billing Platforms and EHR systems 

• Prior experience working with claims and communication with health networks 

• Proficiency in Microsoft (Mail, Docs, Sheets, Calendar). 

• Associate's degree or higher 

• Medical Billing Certificate 

• Experience in Medical Billing and Primary Care Billing 

Benefits

• 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 holiday PTO/year
• Paid vacation and sick days 
• Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans