Billing Specialist Jobs

About The Position

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.