Billing Specialist

SOUTH COAST COMMUNITY SERVICES•Placentia, CA

28d•$24 - $33•Onsite

About The Position

The Billing Specialist is responsible for accurately and timely processing Medi-Cal claims and County invoices based on documented FSP-HFW services. This role involves entering billing data, verifying client eligibility, managing claims through submission and payment, and maintaining billing records. The specialist will work with various systems including IRIS and EHR, and will be involved in the full claims lifecycle from intake to payment reconciliation and accounts receivable tracking.

Requirements

High school diploma or equivalent.
At least 2 years of healthcare claims billing experience, preferably Medi-Cal or County behavioral health (SMHS).
Familiarity with CPT and HCPCS codes, CMS-1500 and 837P claims, eligibility verification, and reading 835 remittances.
Strong attention to detail.
Intermediate Excel skills.
Experience working in an EHR.
Ability to drive a motor vehicle without restrictions, often in heavy traffic and frequently long distances (one hour or more).
Senses of vision, hearing and smell sufficient to regularly operate a motor vehicle, to visualize threats in the environment and operate safely.
Required to occasionally lift and carry 10-20 pounds.
Regularly required to sit, stand, climb stairs (1 or more flights) and walk.
Regularly required to sit and use computer in office settings.
County BHS New User Training (required for anyone who enters data in the County billing system).
Annual Provider Training.
Annual Compliance Training.
HIPAA/42 CFR Part 2 training.

Nice To Haves

Associate degree or a medical billing certificate.
myEvolv (Netsmart) experience.
CPB or CMRS certification.
Experience with Orange County HCA's IRIS system.
Bilingual (English/Spanish or English/Vietnamese) for eligibility follow-up with families.

Responsibilities

Obtain IRIS referral documents and provide them to the Intake Specialist, including client history, Medi-Cal eligibility, Special Cohort status, and CANS/PSC-35 status.
Verify Medi-Cal eligibility and other insurance at intake and monthly, flagging clients with lapsed or changed coverage.
Create client intake profiles in IRIS, including Special Cohort designation.
Enter CANS and PSC-35 results in IRIS.
Update client demographics in IRIS as needed.
Review services entered in the EHR for billing completeness (codes, units, dates, rendering provider NPI, location) before claims submission.
Enter and submit claims through the County billing system (IRIS) and 837 claim files.
Manage denial and rejection queues by identifying causes, sending corrections to staff, and resubmitting claims on time.
Correct any services billed by mistake within 10 calendar days.
Post payments and remittances (835s), reconcile them to submitted claims, and track accounts receivable by age.
Assist in preparing the monthly County invoice and its backup.
Complete Coordination of Benefits before billing Medi-Cal.
Discharge clients in IRIS and close the episode of care (EOC) on time when they leave the program.
Maintain the rendering-provider list, including new hires' NPIs, credentials, and taxonomy, and report NPIs to the County.
Maintain billing records (claims, remittances, invoices, supporting time records) in a form ready for audit and retention.
Use assigned IRIS token and return it upon leaving or no longer needing access.