Senior Billing Specialist

Summary
The Billing Administrator will review and verify through the use of reports that client records are complete for a successful transmission of medical claims for reimbursement from Department of Mental Health and private third party providers. The Billing Administrator is responsible for ensuring that information is processed accurately and timely, and is Familiar with concepts, practices, and procedures for all billing claims to Department of Mental Health (DMH) using the Electronic Health Record (EHR) software EXYM.

 
Essential Duties and Responsibilities

• Submit timely weekly billing to Los Angeles County Department of Mental Health and third party payers using EHR, EXYM and Office Ally.
• Collaborate with QA Department to oversee the electronic health record, EXYM; for billing, case closures, location, funding sources and productivity updates.
• Review, manage and develop billing procedures as needed to maintain compliance with local, state and federal regulations.
• Knowledge of use and application of Current Procedural Terminology (CPT) Codes.
• Identify and notify management of denial patterns and issues.
• Responsible for data tracking and reporting.
• Manage, track and resolve denied and voided claims, following through until claim is paid.
• Responsible for weekly download of SIFT Data. Review data for claim accuracy in DMH/IBHIS and EXYM systems.
• Collaborate and consult effectively with Clinical Quality Assurance, Mental Health and any other staff/programs to ensure adherence to policies and procedures.
• Generate and distribute statistical management reports to leadership, identifying unfiled, pending, denied, and submitted claims.
• Responsible for maintaining the highest level of billing standards following current guidelines from Medi-Cal, and other insurance entities.
• Understand how mental health staff in electronic databases (NAPPA, NPPES) affects billing accuracy and completion.
   
• Check Medi-Cal eligibility on a bi-monthly basis for all clients and compiling list of clients with terminated Medi-Cal as needed, and provide management reports.
• Attend internal and external meetings and trainings.
• Perform a variety of general clerical duties; prepares a variety of routine correspondence, forms, reports and similar items using word processing and Excel Spreadsheet.
• Develop and maintain claim resolution skills through continuous trainings, workshops and education.
• Other duties as assigned.

• Qualifications:
• High school diploma or GED and a minimum of 3 years’ recent experience in Los Angeles Department of Mental Health (DMH) billing.
• Experience in Electronic Health Record EXYM preferred.
• Knowledge of and expertise in third party payers and Medi‐Cal billing.
• Computer skills with strong proficiency in Microsoft Office Software (Excel, Outlook and Word).
• Strong written and oral communication skills, presenting financial results to all relevant parties.
• Excellent data management skills.
• Able to be accurate, precise, and thorough and detail oriented.
• Ability to perform mathematical and data processing tasks rapidly and accurately.
• Demonstrates ability to handle multiple tasks simultaneously and to work independently.
• A self-starter, with ability to coordinate multiple projects/tasks at once.
• Possess problem solving and conflict resolution skills and exercises professional judgement.
• Flexible, adaptable, and capable of working in a fast paced, professional environment.
• Maintain and execute confidential information using HIPAA standards.
• Covid-19 vaccinated and boosted or with a medical/religious exemption.

WORK ENVIRONMENT

• Office environment.
• Regularly required to sit, stand, bend; occasionally lift or carry up to 25 lbs.
• On occasion walk or drive to different agency sites.
• May necessitate working in busy and loud environments.
• May be exposed to elements like cold, heat, dust, noise and odor.
• May need to bend, stoop, twist, and sit throughout the day.

RESPONSIBILITIES COMMON TO ALL AGENCY EMPLOYEES

1. Maintain a safe work environment and confidentiality at all times.
2. Be proactive, creative, and flexible in determining, evaluating, researching, and resolving issues.
3. Organize and prioritize multiple activities to meet all external and internal deadlines.
4. Maintain professional demeanor that reflects positively on the agency.
5. Demonstrate respect and courtesy toward others.
6. Able to thrive in a work environment emphasizing teamwork and collaboration.
7. Respond within 48 hours to all requests.
8. Work with minimum supervision.
9. Perform other duties as assigned.