Billing Specialist (51389)

POSITION SUMMARY:
The CalAIM Billing Specialist is responsible for ensuring accurate and timely billing for CalAIM justice-involved pre-release services. This position supports program operations by verifying documentation, preparing billing submissions, monitoring reimbursement, and ensuring compliance with Medi-Cal and Managed Care Plan billing requirements. Essential Job Functions are below.

ESSENTIAL JOB FUNCTIONS:

• Review program documentation to ensure services meet CalAIM, Medi-Cal, and Managed Care Plan billing requirements.

• Prepare and submit billing for CalAIM services, including Enhanced Care Management and applicable pre-release services.

• Verify eligibility, enrollment, and service authorization requirements prior to billing submission.

• Coordinate with program staff to ensure documentation supports billable services and meets required standards.

• Monitor billing activity, track claims submissions, and follow up on denied or pending claims.

• Work with Managed Care Plans to resolve billing discrepancies and reimbursement issues.

• Maintain accurate billing records and ensure timely submission of claims.

• Generate billing reports and provide updates to program leadership regarding billing status and reimbursement trends.

• Support compliance with regulatory and contractual billing requirements.

• Assist in the development and implementation of billing procedures related to CalAIM services.

• Embrace and embody the mission, vision, guiding principles, clinical vision, and goals of WestCare Foundation.

• Perform other duties as assigned.