Billing Coordinator

North Marin Community Services•Novato, CA

3d•Onsite

About The Position

The Billing Coordinator is responsible for supporting the management of billing, data, and reporting processes for CalAIM and behavioral health initiatives. This role ensures accurate coding, claims tracking, billing, and reporting of the services rendered with a focus on compliance and program integrity. The ideal candidate will have a strong background in healthcare billing, including coding and claims submission, an understanding of Medi-Cal regulations, and the ability to analyze and validate billing data. This role is expected to coordinate with any third-party billing vendor; coordinating day-to-day billing execution, reconciliation and revenue cycle management (RCM). The Billing Coordinator must have sufficient knowledge of billing and RCM workflows to support oversight, validate vendor outputs, resolve discrepancies, and ensure alignment with CalAIM and Medi-Cal requirements. This position is essential for ensuring that services are billed correctly, claims are processed and reviewed efficiently, and data is leveraged for strategic decision-making.

Requirements

Three years of professional healthcare billing experience including preparation of financial statements.
Proficiency in Microsoft Excel (advanced functions, pivot tables, data validation).
Knowledge of CalAIM and health plan-specific reimbursement guidelines and experience with state-funded healthcare programs.
Medi-Cal Provider Manual for Billing and Policy and Program and Eligibility.
Treatment Authorization Request (TAR) process.
Medical reimbursement programs and complexity of payment systems.
Current Procedural Terminology Codes (CPT) codes, International Classification for Diseases (ICD)-10 codes, Health Care Procedure Coding System (HCPCS) codes for payment processing of Medicare and/or Medi-Cal.
Ability to work with billing vendors and platforms as required.
Familiarity with different case management systems.
Strong attention to detail and ability to work with billing data.
Excellent problem-solving skills, with the ability to troubleshoot billing and data issues independently.
Effective communication skills, both written and verbal.
Efficient time management skills and ability to manage own workflow.
Strong team player; ability to collaborate with diverse individuals and across departments within all levels of an organization.

Nice To Haves

Bilingual in English/Spanish
Medical billing experience within a nonprofit behavioral health organization
Bachelor’s Degree in Public Health, Healthcare Administration, Business, Accounting, or a related field.

Responsibilities

Prepare and review information necessary for CalAIM and behavioral health service billing, ensuring compliance with Medi-Cal billing requirements and program guidelines.
Ensure claims are submitted accurately and within required payer filing deadlines.
Verify service dates, billing codes, modifiers, units, provider information, and supporting documentation prior to claim submission.
Review and validate completion of all required billing documentation (i.e. care plans, Treatment Authorization Request (TAR) submissions and approvals, client eligibility verification, authorization approvals) ensuring completeness, accuracy, and compliance with payer requirements prior to claim preparation and submission.
Contribute to the identification, research, and resolution of billing discrepancies and denials, working closely with the billing vendor and finance department to ensure timely and accurate payments.
Advise and consult with management on how to reduce the days in accounts receivable regarding Medicare, Medi-Cal, or other insurance.
Works with the billers and management to identify areas where reimbursement delays may be decreased.
Maintain comprehensive records of billable services, tracking utilization, service delivery, and outcomes. This process is currently managed by a third-party vendor, and the function will be transitioned to an internal process.
Extract, validate, and analyze claims data from multiple sources to generate detailed reports for internal and external stakeholders.
Assist in developing monthly, quarterly, and annual reports as required by program guidelines and for program performance and compliance reviews.
Ensure billing practices adhere to all applicable state and federal regulations, including Medi-Cal, CalAIM, CYBHI and other program requirements.
Participate in audits and compliance reviews, preparing necessary documentation and responding to inquiries from auditors.
Work progressively with the appropriate departments to identify and resolve regulatory conflicts.
Maintain an up-to-date understanding of CalAIM and ECM/Community Supports and behavioral health requirements, including changes in reimbursement policies and procedures.
Ensure billing activities comply with HIPAA, DHCS requirements, managed care contracts, funding agreements, and organizational policies.
Act as a liaison between the billing, Case Management and Mental Health teams to ensure accurate data sharing and alignment.
Collaborate with internal teams to identify process improvements and implement best practices for data management and billing workflows.
Support the development of effective training for staff and conducts training on the specific areas of Managed Care/Medicaid/Medi-Cal/Medicare and/or Commercial Insurance.
Serve as the point of contact for billing-related inquiries, providing support to program staff, providers, and external partners.
Participate in agency meetings and North Marin Community Services’ sponsored cultural events.
Support office management tasks and assist with general office operations as needed.
Perform clerical duties, including data entry, archiving, and organizing as needed.
Other administrative duties as assigned for program efficiency.
In coordination with the billing and case management/EHR vendors, contribute to the management and update of software as appropriate to ensure accurate setup of service codes and reimbursement rates for Medi-Cal services.
Monitor and maintain data integrity within the EHR system and other tracking tools.
Support system upgrades and testing, ensuring new features and configurations are aligned with billing requirements.
All other relevant duties as assigned.