Job Information
ILLUMINATION FOUNDATION Senior Claims Specialist in Santa Ana, California
“Every person deserves compassion, dignity, and the safety of a place to call home.”
Homelessness is the largest social and public health crisis in California. Illumination Foundation (IF) is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care centers, emergency shelters, housing services and children's and family programs. IF currently has 13+ facilities with 22+ micro-communities scattered across Orange County, Los Angeles County and the Inland Empire.
Job Description
The Claims Specialist is responsible for accuracy of claims submission, benefits and eligibility verification, accuracy of client information. In addition, the Claims Specialist is also responsible for keeping up to date accounts receivable for both CalAIM and IFMG, claim follow-up, and must have knowledge of billing codes.
The pay range for this position is $28.00 - $30.00 per hour, depending on experience. After successful completion of 90-day probation period, this position will be eligible for Hybrid schedule with 2 days in office and 3 days working from home.
Responsibilities
CalAIM Billing and Follow up
Ensure claims meet the standards of our contracts and programs.
Review any rejected or denied claims and conduct proper follow up procedures.
Verifying authorizations via provider portals or authorization letters on Kipu prior to claim submission.
Reviewing claims prior to e-claim submission to ensure a clean claim is sent.
Review and follow up on escalated provider dispute resolutions.
Review billing sheets for claims on hold and share with corresponding departments for further review.
Follow up on claims on hold and bill when claims are determined ready to bill.
Reviewing data and creating Claims for services rendered (as needed).
Review client records to extract applicable data necessary for billing purposes, including but limited to ICD 10 Diagnosis codes, CPT codes for services rendered etc(as needed).
Verifying eligibility prior to claim submission via provider or DHCS portals (as needed).
Have knowledge in understanding, reading EOB’s and Remittance Advice
Posting payment accurately to claims and continuing with the claim close out process (as needed).
Assist supervisors in any projects related to billing that may come up.
Preferred Experience/Minimum Qualifications
Required:
High School Diploma or equivalent.
1-2 years' relevant experience.
Basic computer skills, including the ability to send and receive emails and summarize data in spreadsheets.
Valid CA Driver’s License and eligibility for company vehicle insurance.
Prior experience work in Electronic Billing Platforms and EHR systems
Prior experience working with claims and communication with health networks
Preferred:
Proficiency in Microsoft (Outlook, Word, Excel, Teams).
Bachelor's degree
Experience in Medical Billing and Primary Care Billing
Medical Billing Certification
Benefits
Hybrid schedule with 2 days in office and 3 days working from home (After successful completion of 90-day probation period)
Medical Insurance funded up to 91% by Illumination Foundation (Kaiser and Blue Shield), depending on the plan
Dental and Vision Insurance
Life, AD&D and LTD Insurance funded 100% by Illumination Foundation
Employee Assistance Program
Professional Development Reimbursement
401K with Company Matching
10 days vacation PTO/year
6 days sick PTO/year
10 days holiday PTO/year
Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans
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