Billing Specialist - Special Service for Groups, Inc- HOPICS : Job Details

Special for Service Groups IncJob Announcement Title: Billing Specialist Division: HOPICSFLSA: Non-Exempt, full time Supervisor: Billing & Compliance ManagerPay Range: $27-$30 per hour Per hour Revised: 10.08.24 SummaryUnder the supervision of the Billing & Compliance Manager, the individual will provide clerical support and billing administration to the Adult Outpatient Program (AOP), Drug Medi-Cal (DMC), Recovery Bridge Housing (RBH), and the CalAIM Community Housing Navigation Services (CHNS) programs.Essential Functions

• Check Medi-Cal eligibility on new clients and verify Medi-Cal status on active clients on a weekly basis for all programs.
• Process new clients in Data Based System.
• Input data, run billing reports, and scan all documents into the Data Based System.
• Ensure Data Based System is accurate and up to date by utilizing a client tracking sheet to keep track of missing documentation.
• Provide program-specific reports on a weekly and monthly basis.
• Verify the accuracy of the state and county reports.
• Responsible for all data entry of billing with a monthly deadline for payment.
• Investigates and resubmit denied claims.
• Produces productivity reports and multiple staff reports.
• Keep up to date with all the forms (revision) and add to files as necessary.
• Prepares, approves, reviews, and processes CHNS documentation.
• Provide clerical support to staff and CHNS Program Supervisor.
• Work closely with BHS Treatment Providers to ensure that required paperwork is received and processed in a timely manner.
• Collaborate with BHS team tracking of the BHS client rosters.
• Attending and reporting updates from the QNQI Monthly Meeting.
• Review and resubmission of the BHS billing denials at the county and state level.
• Attend all necessary training/meetings to become familiar with EHR systems.
• Maintain BHS contact lists and produce mass mailings.
• Attending program specific meetings related to BHS Network Adequacy, Financial, Quality Assurance and Program Development.
• Ability to understand BHS programs outcome measure tools and other data collection.
• Coordinate with SSG Quality Assurance for the development of the process and procedure.
• Assist with training new staff in program specific requirements.
• Responsible for all data entry of billing with a monthly deadline for payment.
• Update Data Based System to update, track, and edit client information (Clinitrak, Exym, SAGE, SAPC e-Billing System, LACPRS, etc.).
• Input data in Data Based System.
• Run billing reports in Data Based System.
• Create client tracking sheet to keep track of client missing documentation.
• Investigates and resubmits denied claims (i.e. incorrect start date, deletion of client or billing, etc.).
• Assist with auditing clients' charts for quality assurance.
• Keep up to date with all the forms (revision) and add to charts as necessary.
• Prepares, approves, reviews and process BHS documentation.
• Review and process all corrections needed in Data Based System and charts.
• Responsible for cross-checking all new charts to ensure accuracy.
• Ensure billing is accurate prior to submission into Data Based System.
• Establish and maintain collaborative partnerships with funder.
• Reviews and evaluates all MIS inquiries for processing (i.e. transfer, coordination, etc.).
• Trains new staff on MIS functions.
• Performs other assignments under direction of Billing & Compliance Manager, Associate Director of Contract, Compliance & Performance, and Division Director.
• Ability to solve clerical issues.
• Ability to multi-task and daily problem solving.
• Provide quality customer service.
• Coordinate and help set-up for provider and staff meetings.
• Conducts evaluations and assessments of current practices to identify treatment alternatives and strategies for the delivery of programs and individualized services.
• Reports evaluation/assessment findings of client charts and EHR system.
• Identifies problems by consulting with professional and support staff, reviewing client complaints, observing staff performance, monitoring program implementation, and reviewing records (Assessments, Treatment Plan and progress notes), reports, special studies, and utilization/financial data.
• Evaluates programs and services for compliance with accreditation and/or certification standards.
• Assists in the development and maintenance of policies and procedures, operational guidelines, and contractual agreements relating to compliance standards.
• Assist in the completion of the quality assurance reports (quarterly/yearly).
• Maintain appropriate boundaries; and adhere to SSG's Code of Ethics and HOPICS' Core Values.
• Represent the Agency in a professional manner at meetings and community events.
• Maintain files/records on client services in compliance with HIPAA & CFR42 and other funding requirements for auditing purposes.
• Regular attendance required.
• Provide clerical support to staff and division director
• Overtime, holiday, or weekend work maybe required
• Perform other duties as assigned by the supervisor
• Minimum Qualifications- Knowledge, Skills and Abilities Required
• Minimum of three years job related experience
• Ability to think and work effectively under stress and in emergencies
• Ability to understand and carry out oral and written directions
• Friendly voice and clear enunciation
• Ability to do simple clerical work with speed and accuracy

Minimum Qualifications - Knowledge, Skills and Abilities Required

• High School Diploma/GED and Medical Billing Certificate.
• Minimum of one (1) year of DMH experience.
• Ability to work with clients from diverse cultural, ethnic, and socio-economic backgrounds.
• Ability to pay attention to detail, work independently, and exceptional organizational skills. Good basic clerical skills, including typing, ability to proofread own work, good grammar, and spelling.
• Verification of Employment Eligibility and Background Clearance.
• TB test required (Not more than (3) month prior to or (7) days after Date of Hire, and renewed annually thereafter), CPR and First Aid Certification required within 30 days of employment with company.
• California Driver License, Proof of Car Insurance, Reliable transportation.
• Verification of Employment Eligibility and Background Check.
• If in recovery, a minimum of three (3) years of being drug and alcohol free is MANDATORY.

Supervisory Responsibilities

• This position does not have any supervisory duties.

Environmental Conditions (Working Conditions)

• May be exposed to aggressive clients: must work in conjunction with other collaborative staff members; communicate with many sources including courts, Los Angeles County Department of Probation, Department of Children and Family Services and other community agencies.
• Some evenings and weekends may be required.
• Local automobile travel may be required.
• There is some responsibility to work in noisy environments where adults are free to talk loud and expressive; must be able to work effectively and produce quality work under pressure.

Physical Requirements

• In the course of performing this job, the incumbent typically spends time sitting, standing, walking, driving, speaking, and listening.
• Must sit at computer for data entry and reports: sometimes spend time driving and walking and carrying equipment/files/charts.
• Speak to staff and outside agencies in public meetings and Provider Meetings. Represent the Agency in a professional and positive manner.
• Typically spends time sitting, standing, walking, typing, thinking, bending, reading, and writing.
• Physical effort may include occasional light lifting (25 lbs), and some reaching, bending, stopping, walking and squatting.

Mental Requirements

• Must be able to handle multiple tasks; constant distractions; ongoing deadlines; interruptions, uncontrollable changes in priorities/work schedules; budgetary cuts and reductions; staff changes and reductions; be able to process volumes of information, think, and conceptualize and transfer knowledge on best practices.

Special Service for Groups is an Equal Opportunity/Affirmative Action Employer