Description:

Billing Specialist

Job Description

EXEMPT: No SALARY LEVEL: $30 - $35 per hour

DEPARTMENT: Finance LOCATION: Remote with some in office work, Santa Rosa, CA

REPORTS TO: Director, Finance & Controller HOURS: FT (40 hours per week)

Date: 03/25/ 2024 APPROVED BY: Human Resources Director

AGENCY BACKGROUND: The objective of Community Action Partnership of Sonoma County (Community Action) is to partner with low-income families and individuals to help them to achieve economic and social empowerment, to build community, and to advocate for social and economic justice. Community Action operates a wide variety of programs benefiting low-income Sonoma County residents.

Our Mission: CAP Sonoma is a catalyst of equitable transformation, aligning partners and resources to implement values-based, data-driven, community-led solutions that help families reach their full potential.

Our Vision: We see our Sonoma County transformed into an empowered community of thriving families where every child is raised with joy, justice, and connection.

Our Values:Joy, Amor, Esperanza, Equity, Fuerza, Dignity, Inclusión

Our Promise: CAP changes people’s lives, embodies the spirit of hope, improves communities and makes America a better place to live. We care about the entire community and we are dedicated to helping people help themselves and each other.

AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER

Community Action Partnership of Sonoma County is an Equal Opportunity/Affirmative Action Employer. Affirmative action involves determining areas of workforce under-representation, locating qualified protected class candidates by enlarging the recruiting base and developing the skills they need to succeed in those new positions.

Our obligations in this area stem from not only adherence to various state and federal regulations, but also from our commitment to create a culture of inclusiveness and diversity where members of our community thrive and are able to reach their full potential.

TOTAL COMPENSATION PACKAGE: Salary for this position is $30 - $35, depending on experience. CAP offers a generous benefits package available on the first day of the month after your date of hire that includes:

• Medical insurance through Kaiser or Sutter 80-95% paid by the employer for employee premiums plus 50% paid by the employer for dependent coverage
• Elective dental, vision insurance, FSA and Accident insurance.
• Employer paid $10k of life insurance with expandable options
• Employer paid Long-term Disability Insurance
• 401(K) plan with 2% contribution and an additional 1% matched contribution after one year of service
• Employee assistance program, CalPerks
• 3 weeks vacation (4 hours accrued per pay period) based on full time work, increases at 5 years of service
• 96 hours sick time per year (4 hours accrued per pay period) based on full time work
• 1 floating personal day
• 16 paid holidays

SUMMARY OF POSITION:

As the Enhanced Care Management and Community Supports Billing Specialist, you will be responsible for managing the billing and reimbursement processes associated with our specialized care programs through CalAIM learn. Your role involves collaborating with internal teams, verifying documentation, and ensuring compliance with relevant billing regulations. Join us in making a positive impact on the lives of those we serve by supporting the financial aspects of our Enhanced Care Management and Community Supports initiatives.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Duties include but are not limited to the following:

Billing Process:

• Process billing for CAP Sonoma related to CalAIM ECM (Enhanced Care Management) and CS (Community Supports) services in compliance with program requirements.
• Ensure accurate and timely submission of claims to relevant payers.

Documentation Verification:

• Review and verify supporting documentation to substantiate claims and reimbursement; ensure adherence to program guidelines.
• Collaborate with program team members to gather necessary information for billing and standardize reimbursement submission

Reimbursement Coordination:

• Work closely with payers to secure timely and accurate reimbursement.
• Address any issues or discrepancies in reimbursements.

Compliance and Regulations:

• Stay informed about relevant billing regulations, coding updates, and program-specific requirements.
• Ensure adherence to all billing and documentation guidelines to maintain compliance.

Communication and Collaboration:

• Collaborate cross functionally with program management, finance, and administrative teams to resolve billing-related inquiries and discrepancies.
• Provide support in training staff on billing processes and requirements.
• Perform other duties as assigned.

PREFERRED EDUCATION AND EXPERIENCE:

Bachelor’s Degree and/or 4-6 years of experience in medical billing; nonprofit or healthcare system preferred.

Requirements:

REQUIRED SKILLS/ABILITIES:

• Knowledge of MediCal billing processes and regulations; experience with CalAIM and Partnership Healthplan a plus.
• Familiarity with TARs and relevant HCPCS, CPT and ICD codes.
• Familiarity with Healthcare Common Procedure Coding System Reporting
• Detail-oriented with strong analytical and problem-solving skills.
• Advanced proficiency with Microsoft Excel and Word.
• Excellent communication and interpersonal skills.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. This job operates in a professional office and home office environment. The noise level in the work environment is usually moderate.

PHYSICAL DEMANDS:

While performing the duties of this job, the employee is frequently required to sit; use the computer keyboard and mouse, use hands to finger, handle or feel; reach with hands and arms; and talk or hear. The employee may occasionally be required to stand, walk, stoop, and crouch. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of

activities, duties or responsibilities that are required of the employee for this job. Duties,

responsibilities and activities may change at any time with or without notice.