Billing Compliance Specialist

McKinley Children's Center•San Dimas, CA

About The Position

The Billing Compliance Specialist reviews client-record documentation for content and compliance with regulatory and agency standards, supporting day-to-day department functions, billing and claim reconciliation, quality assurance, and periodic reviews of active and discharged client records. The role works with outside agencies to maintain current procedures, participates in regulatory audits, and helps service-delivery staff complete or correct documentation. The position includes tracking and processing county and department documentation, monitoring and correcting claims in the Electronic Health Record, entering billing into county systems, preparing invoices, and processing authorizations and denied claims. The specialist also organizes records for visits and audits and participates in the agency’s Performance and Quality Improvement Plan. The role is based at McKinley, a welfare organization providing residential treatment, mental health services, and special education through locations across Southern California. The listed hourly pay range is $20.00–$22.00, depending on experience.

Requirements

Prior Quality Assurance experience, including knowledge of IBHIS and billing code requirements, or Case Management experience is strongly preferred.
Word processing, email, internet, and basic office skills, including typing, telephone, and copier use.
Ability to learn clinical software.
Microsoft Excel, Power BI, and Adobe Acrobat skills.
Must pass a pre-employment physical exam, TB screening, and drug screening.
Ability to commute to various sites on and off campus.
Ability to work extended hours as needed.
Ability to physically restrain children if needed.
Must meet DOJ, FBI, and Child Abuse Index requirements.
Must be insurable under the corporate automobile insurance.

Nice To Haves

Bachelor’s degree in Social Work, Psychology, Public Administration, or another related discipline preferred.
Prior Quality Assurance experience, including knowledge of IBHIS and billing code requirements, or Case Management experience is strongly preferred.

Responsibilities

Track and process county and department documentation.
Review documentation for compliance with regulatory and agency standards and ensure it reflects a high level of care.
Monitor the accuracy of records, documents, and billing, and reconcile services as needed.
Report documentation deficiencies and compliance concerns promptly to the AVP of Contract Compliance, Director of Compliance, and department VPs and Directors.
Monitor, track, and correct billed claims in the Electronic Health Record on a weekly basis.
Enter Riverside and San Bernardino billing into county systems.
Process denied claims weekly.
Prepare invoices for county billings and monitor payment reports.
Maintain and run claim reconciliation reports.
Process county client authorizations.
Audit client charts monthly.
Assist service-delivery staff with completing or correcting documentation.
Organize and prepare records for visits and audits.
Participate in the agency’s Performance and Quality Improvement Plan.
Perform other related duties as needed.