FQHC Billing Specialist (Temp)

Job Title:    FQHC Billing Specialist

Salary:        Starting at $26 per hour

Location:   Tustin, CA

Openings:   1

Position Purpose: The FQHC Billing Specialist is responsible for overseeing the billing and accounts receivable processes for CalAIM claims. This role requires effective communication with various departments involved in submitting claims to CalOptima, as well as a strong familiarity with CalAIM processes, guidelines, and reimbursement methodologies.

Core Duties and responsibilities include but are not limited to: 

1. Billing and Coding:
   
   
   
   • Generate and submit accurate claims.
   
   
   • Assign appropriate ICD-10, CPT, and HCPCS codes for services provided.
   
   
   • Review and correct rejected claims and denials through Cal-Optima.
   
   
   
   


2. Accounts Receivable Management:
   
   
   
   • Post payments, create Excel spreadsheets, pivot tables, and graphs, and analyze data.
   
   
   • Monitor, report, and follow up on unpaid claims and outstanding balances.
   
   
   • Identify and resolve billing issues, disputes, and discrepancies in a timely manner.
   
   
   • Conduct regular accounts receivable aging analysis and assist in developing strategies to reduce outstanding balances.
   
   
   • Ensure compliance with commercial insurance billing guidelines and all other relevant local, state, and federal laws and regulations.
   
   
   • Prepare and submit regular billing, financial, and productivity reports to the manager.
   
   
   
   

This job description in no way states or implies that these are the only duties to be performed by the employee. He or she will be required to follow any other instructions and to perform other duties, within scope, as assigned by his or her supervisor. 

Education, Qualifications, and Experience:

• Associate’s or Bachelor’s degree in healthcare administration, medical billing, or a related field preferred.

• Must have at least 3 years of experience in billing FQHC.


• Must have a minimum of 3 years of experience working with CalOptima/Medi-Cal insurance and be familiar with their guidelines.


• Intermediate level of Excel knowledge.


• Strong computer skills, acute attention to detail, confident and professional communication.


• Responsiveness to the needs of both internal/external stakeholders in a professional and personable manner are expected.


• Knowledge of general EMR/EHR systems is preferred.


• Familiarity with the CalOptima and Medi-Cal websites is required.

Work Schedule:  

• General work hours are Monday to Friday, 9 a.m. to 6 p.m., however, start times will vary, depending on organizational, staffing, community, and patient needs.  

• Work schedules are subject to change based on organizational, staffing, community, and patient needs. As such, FTOC may need to modify work schedules to meet such needs.   

• Saturday work schedules will also be affected or implemented due to organizational, staffing, community, and patient needs as FTOC continues to grow and expand work days and hours.  

• Overtime may also occur due to organizational, staffing, community, and patient needs.  

Families Together of Orange County (FTOC) is proud to be an equal opportunity employer.  FTOC does not discriminate based on race, color, creed, sex, sexual orientation, gender identity or expression, age, religion, national origin, disability, ancestry, marital status, veteran status, medical condition, or any protected category prohibited by local, state or federal laws.