Medical Biller - Cal AIM

• Prepare, submit, and track claims for ECM, Recuperative Care, Community Supports, detox billing, and other Cal AIM service lines.
• Verify eligibility and authorization requirements for all Cal AIM beneficiaries.
• Ensure documentation meets Cal AIM billing standards, including encounter data, activity logs, and service notes.
• Reconcile encounters and claims to identify discrepancies or missing documentation.
• Process claims corrections, resubmissions, and voids as needed.
• Collaborate with ECM/CS/RCP program staff, care managers, and supervisors(stakeholders) to clarify documentation needs and share reconciliation reports of reimbursements.
• Communicate with Managed Care Plans regarding claim follow-up, denials, Appeals and payment discrepancies.
• Provide feedback and training to program staff regarding billing requirements and documentation best practices.
• Maintain accurate records of claims, payments, denials, Appeals and adjustments.
• Generate billing reports, productivity summaries, and revenue tracking related to Cal AIM services.
• Support audits and data validation efforts as required.
• On time, completion of assigned training and policies.
• Performs other duties as assigned.

• High school diploma or equivalent.
• 5-7 years of medical billing experience.
• Knowledge of Medi-Cal or Medicaid billing processes.
• Strong data entry accuracy and attention to detail.
• Ability to review clinical documentation and apply billing rules.
• Experience with CalAIM, ECM, or Community Supports billing.
• Familiarity with DHCS/health plan portals.
• Proficient computer skills, with intermediate proficiency in MS Office (Word, Excel, and PowerPoint)

Pay Band N5: