Billing Specialist

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.
 

ESSENTIAL QUALIFICATIONS:
To perform this job successfully, an individual must be able to perform the duties and responsibilities satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Experience and Competencies:
•    Strong attention to detail, organizational skills, and ability to manage multiple deadlines.
•    Valid driver’s license and ability to obtain and maintain WestCare’s vehicle insurance is required.
•    Ability to obtain and maintain successful background clearance.
•    During your tenure with WestCare there may be new requirements, including, but not limited to vaccinations that are issued by local, State, Federal, and/or Funders that WestCare may have to comply with. Should this occur Human Resources or appropriate personnel will inform you.
•    CPR Certification, First Aid Certification, and an annual Tuberculosis test. 

EDUCATION and/or EXPERIENCE:
•    Experience with Medi-Cal, CalAIM, Enhanced Care Management, or healthcare billing preferred.
•    Knowledge of healthcare documentation and billing practices.
•    High school diploma or equivalent required; associate or bachelor’s degree preferred.

LICENSURE/CERTIFICATION:
•    Not applicable for this position.

WORKING CONDITIONS:
•    Work is performed in a combination of correctional facilities, office environments, and community settings.
•    Regular interaction with justice-involved individuals and multidisciplinary care teams.
•    Local travel is required to correctional facilities, partner agencies, and community providers.