Medi-Cal Billing & Claims Specialist

South Coast Community Services; Placentia (CA); On-site; USD 42,000 - 66,000; Full time

Job summary

South Coast Community Services is seeking a Billing Specialist to convert documented services into accurate Medi-Cal claims and county invoices. You will post data in IRIS, submit 837 files, and monitor denials, ensuring timely resolution and payments.

The role emphasizes adherence to billing procedures, verification of eligibility, and updating EHR records. Proficiency in Excel and CPT/HCPCS codes is important, with strong attention to detail and compliance.

Qualifications

• High school diploma or equivalent required; assoc. degree or medical billing certificate preferred.
• At least 2 years of healthcare claims billing experience, preferably Medi-Cal or County behavioral health (SMHS).
• Familiarity with CPT/HCPCS, CMS-1500 and 837P, eligibility verification, and 835 remittances.
• Strong attention to detail, intermediate Excel, and EHR experience (myEvolv/Netsmart) preferred.

Responsibilities

• Obtain referral documents and relay to Intake Specialist with patient history and eligibility details.
• Verify Medi-Cal eligibility and other insurances at intake and monthly updates.
• Create client intake profiles in IRIS and record special cohort designations.

Skills

Healthcare billing

Attention to detail

Excel

EHR experience

Eligibility verification

Education

High school diploma or equivalent

Medical billing certificate preferred

Tools

IRIS system

CMS-1500 & 837P

Job description

South Coast Community Services is seeking a Billing Specialist to convert documented services into accurate Medi-Cal claims and county invoices. You will post data in IRIS, submit 837 files, and monitor denials, ensuring timely resolution and payments.

The role emphasizes adherence to billing procedures, verification of eligibility, and updating EHR records. Proficiency in Excel and CPT/HCPCS codes is important, with strong attention to detail and compliance.