Medical Billing Specialist

Job Title:

Medical Billing Specialist (Enhanced Care Management)About OverSightMD OverSightMD is a leading provider of Enhanced Care Management (ECM) services. We specialize in coordinating care for high-need individuals, ensuring they receive the medical, social, and behavioral support they require. We are looking for a dedicated Medical Billing Specialist to join our team and ensure our vital services are accurately coded and reimbursed. Role Overview As our Medical Billing Specialist, you won't just be "crunching numbers." You will be the backbone of our financial operations, ensuring that the complex claims associated with ECM and Community Supports are submitted accurately and on time. You will work closely with our clinical teams to bridge the gap between patient care and payer reimbursement.

Key Responsibilities Claims Management:

Prepare, review, and submit electronic claims to Medi-Cal managed care plans and third-party payers.

ECM Expertise:

Utilize specific HCPCS codes (e.g., G9008) and modifiers associated with Enhanced Care Management and Ca-lAIM initiatives.

Denial Management:

Identify, research, and resolve claim denials or underpayments; file appeals when necessary.

Compliance:

Maintain strict adherence to HIPAA regulations and stay updated on evolving state and federal billing guidelines.

Reporting:

Generate weekly aging reports and provide updates to leadership on outstanding accounts receivable.

Collaboration:

Coordinate with care managers to ensure documentation supports the complexity of the services billed.

Qualifications & Skills Experience:

Minimum 2-3 years of medical billing experience, preferably with Medi-Cal or Managed Care Plans (MCPs).

Knowledge:

Strong understanding of ICD-10 and HCPCS coding. Specific experience with Cal-AIM or ECM billing is a major plus.

Tech-Savvy:

Proficiency in billing software (EMR/EHR) and Microsoft Excel.

Detail-Oriented:

An eagle eye for errors that lead to "clean claim" rejections.

Communication:

Ability to explain complex billing issues to non-billing staff with clarity and patience. Benefits & Perks Competitive salary and performance bonuses. Health, dental, and vision insurance. Opportunity to be at the forefront of healthcare innovation in California.

Job Types:

Full-time, Part-time Pay:

From $28.00 per hour Expected hours: 25 - 30 per week

Benefits:

401(k) Professional development assistance

Work Location:

In person