BILLING SPECIALIST - CCSEP

NHA•San Diego, CA

2d•Onsite

About The Position

Under the supervision of the Billing Specialist II, the Billing Specialist performs a range of administrative, billing support, and reimbursement-related duties in support of Medi-Cal reimbursable behavioral health services. This position is responsible for the timely and accurate entry, review, and maintenance of client eligibility, billing, and service data within the Electronic Health Record (EHR). Duties include generating and reviewing routine billing, service, and error reports to identify documentation and charge discrepancies; coordinating with providers, supervisors, and program staff to ensure timely resolution of errors; verifying insurance eligibility; preparing and submitting billing-related documentation; and providing general administrative and customer service support to program operations.

Requirements

Knowledge of medical and behavioral health billing principles, including Medi-Cal reimbursement requirements and County or County-contracted billing systems
Experience with insurance eligibility verification and claims processes, including Medicare and Other Health Coverage (OHC)
Ability to generate, review, and analyze EHR billing and service data to identify and resolve errors
Knowledge of documentation standards required to support Medi-Cal reimbursable services
Familiarity with HIPAA regulations, confidentiality requirements, and compliance standards
Experience working with culturally diverse populations and understanding of behavioral health-related social, economic, and systemic factors
Ability to apply sound judgment within established policies and procedures
Strong written and verbal communication skills
Proficiency with computers, EHR systems, and standard office software applications
Ability to operate standard office equipment and perform administrative support functions
Completes all other duties as assigned by Supervisor and Program Director.
Ability to effectively present information and respond to questions primarily in English from managers, providers, County billing staff, clients, and the general public; demonstrated skills in clear, professional written and oral communication related to billing, documentation, and data correction issues.
Ability to add, subtract, multiply, and divide using whole numbers, common fractions, and decimals; ability to review units, dates of service, and billing data for accuracy and consistency.
Ability to define problems, collect and review EHR and billing data, establish facts, and draw valid conclusions; ability to interpret technical billing instructions, compliance requirements, and documentation standards and apply them to service correction and billing support activities.
A high school diploma or G.E.D. equivalent
At least three (3) years of clerical, billing, or administrative experience in a healthcare, behavioral health, or social services setting with supervisory experience
A Valid Driver’s License with current California automobile insurance
A Valid Cardiopulmonary Resuscitation (CPR) Certification
A valid Tuberculosis (TB) test upon hire and updated every two to four (4) years depending on the contract requirements

Nice To Haves

Bachelor’s degree preferred
Experience supporting Medi‑Cal billing processes in a County or County‑contracted program preferred
Billing and financial training and/or certification highly desirable
Experience and training in SmartCare or similar behavioral health EHR systems highly desirable

Responsibilities

Completes insurance eligibility verification for Medi-Cal, Medicare, and Other Health Coverage (OHC) in accordance with program and billing requirements
Tracks, documents, and follows up on corrections to ensure accurate and complete service records prior to billing submission
Provides administrative and clerical support to program operations, including preparing correspondence, scheduling meetings, maintaining calendars, and responding to telephone inquiries
Assists with electronic health record (EHR) and information system functions including data entry, corrections, report generation, scheduling, and billing support activities
Collects, organizes, and prepares monthly program documentation and reports to support billing and reimbursement processes
Develops, organizes, and maintains billing, filing, and recordkeeping systems to ensure accuracy and accessibility of records
Creates, updates, and maintains databases and tracking systems related to program services, billing, and reporting requirements
Assists in preparing monthly program, billing, productivity, and mileage reimbursement reports
Maintains confidentiality of protected health information in compliance with HIPAA, County, and program standards
Completes all other duties as assigned