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Form of workZOE Home for Youth STRTP Medical Billing Specialist
(Mental Health Billing)
Part Time Contractor Preferred- Work From Home Position
Job Description
The ZOE Home for Youth STRTP Medical Billing Specialist is responsible for ensuring billing support to the mental health program including correspondence with the Department of Mental Health (DMH). This position will efficiently handle all DMH billing guidelines and ensure that requirements are followed and the program remains in compliance.
The Medical Billing Specialist 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 Medical Billing Specialist 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.
The primary purpose of this position is to be responsible for all aspects of billing for mental health programs. This will include verifying insurance coverage, submitting claims, following up on outstanding balances, and resolving any claim denials or rejections. The mental health Billing Specialist will also work closely with other members of Department of Mental Health (DMH) staff, including program and administrative staff, to ensure that billing processes are efficient and effective. The mental health Billing Specialist performs high-volume advanced data entry work. Work involves entering, verifying, researching, coding, correcting, billing, collecting, and retrieving information from source documents and/or computer systems with high accuracy. The mental health Billing Specialist is expected to have a thorough understanding of batch processing and FTP files, an ability to interpret error reports and diagnose issues with EHR applications, and execute correction procedures and processes.
Essential Functions:
● Performs all billing data input, information tracking, error correction and follow-up on Department of Mental Health (DMH) contract.
● Performs all required data entry, file maintenance and follow-up related to the Electronic Health Records System “EXYM” software system.
● Assists in maintaining current status on all Mental Health clients’ Medi-Cal eligibility monthly, semi-monthly and weekly.
● Responsible for the Mental Health monthly billing and creating reconciliation reports.
● Responsible for generating management reports to identify any non-reconciled claims.
● Tracks Mental Health billable units per program in EXYM, run billing reports and compare our State Contract Approvals to our submitted billing reports.
● Works through and resubmits all DMH and IBHIS System denials.
● Prepares reports as needed related to the management of the Department of Mental Health contract.
● Attends contract administrative and technical training workshops offered or mandated by Department of Mental Health. Prepares and submits a summary of each meeting to supervisor timely.
● Will at times provide technical assistance, interpretation and guidance to the program staff in matters relating to the compliance of the Department of Mental Health contract.
● Responsible for assuring that all billing policies and procedures are followed.
● Responsible for staying abreast of all Department of Mental Health policies and procedures as it relates to billing and third-party reimbursements (Other Health Coverage billing) and collection.
● Assists in preparing for audits. Work with the Director to assist auditors in gathering documentation/ responses to any audit findings and may be responsible for writing and following up on any action plans needed to correct audit findings.
● Maintains strict confidentiality of all financial data and all pertinent client data information.
- Collaborates to integrate the values of Inclusion, Diversity, Equity and Accessibility (IDEA) into all aspects of the organization.
- Attend and Participate in monthly financial meetings
● Promotes the Continuous Quality Improvement (CQI) process by identifying quality indicators and opportunities for departmental and organizational process improvement.
● Perform other duties as may become necessary or as directed.
Please note that this job description is not exhaustive and additional duties may be assigned as needed.
The Medical Billing Specialist must possess:
- An expertise in EHRs and Medical Billing and coding.
- Minimum of one (1) year of Medical Billing experience.
- Strong organization and interpersonal communication skills;
- Intermediate to advanced working knowledge/experience utilizing Microsoft Office programs with a high proficiency in Excel;
- Ability to maintain sensitive information with the strictest confidentiality;
- Ability to communicate clearly and effectively in English, including reading, verbally, and in writing;
- Must comply with HIPAA confidentiality standards when accessing or communicating patient information;
- Two (2) years of Department of Mental Health (DMH) billing experience is preferred.
*Pay rate will be determined based on qualifications, degree, experience, and/or a combination of those factors.
Other Requirements:
- EXYM proficiency- preferred
- Medi-cal proficiency experience- preferred
- Valid California Driver’s license and a good driving record (Department of Motor Vehicle printout required.)
- Criminal record clearance
- Willingness to sign and adhere to ZOE International’s Code of Conduct, Child Protection Policy, and other
- policies and procedures
- Good physical health to perform duties including standing and walking for long periods, sitting, and liftingup to 25 pounds. (Good health must be verified by a physician or physician-supervised medical
- professional and must include a tuberculosis screening that is given not more than one year prior to
- employment or seven days after the first day of employment and is repeated annually thereafter.)
- Willingness to sign and adhere to ZOE International’s Code of Conduct, Child Protection Policy, and other policies and procedures
Additional Information:
- Benefits for full-time staff include (part-time/contractor benefits vary):
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
