Do you have experience in Medi-Cal billing within Los Angeles County Department of Mental Health (LACDMH)? Are you excited to work independently or as part of a team? Do you feel at home in a supporting role providing assistance to Managers and Social Service staff?
The Claims Specialist for the Los Angeles County Department of Mental Health Wraparound program in Signal Hill, California, is part of a strengths-based, highly skilled and passionate team working together to ensure the safety of youth by providing services centered on improving behavior and maintaining placement in their home.
The Claims Specialist is responsible for improving overall quality and completeness of clinical records. Providing concurrent and retrospective clinical record reviews applying utilization, quality, and risk management services. Providing on-going support to staff with compliance expectations associated with documentation and billing.
Your Skills and Duties
- Submit timely weekly billing to LACDMH using Electronic Health Record System (EHRS), EXYM. Manage, track and resolve denied and voided claims, following through until claim is paid.
- Reviewing the completeness, accuracy, and timely input of all required data entered into LA County and Agency databases (i.e., NAPPA, NPPES, ProviderConnect).
- Knowledge of use and application of Current Procedural Terminology (CPT) Codes, and maintain knowledge of changes from DCHS and LACDMH; responsible for weekly download of SIFT Data.
- Coordinate monthly chart audits with Program Manager/HOS; reviewing charts for compliance, accountability and internal responsibility.
- Generate and distribute accurate and timely reports on a daily, weekly, monthly and quarterly basis, and preparing reports in response to audits including plans of correction
- Monitors programs and services in order to ensure desired changes are effective objectives which are achieved, and program changes are maintained.
- Attend and participate in monthly Peer Review/Compliance meetings per County and Agency guidelines, including LACDMH Network Adequacy and QA/QI Meetings, as assigned.
- Accountable for current knowledge of utilization management responsibilities, including regulations and payer information (i.e. EPSDT, insurance standards).
- Assist Program Manager/HOS to provide oversight and administrative assistance in tracking documents, monitoring best practices regarding documentation and billing, and maintaining client privacy and dignity.
- Reviews Satisfaction Survey and other outcome data and disseminates results and staff/client comments to Program Manager/HOS; assist in the development of systems identified as opportunities for improvement and the collection of this data.
- Demonstrate sensitivity and responsiveness to cultural differences.
- Maintain appropriate professional boundary areas with staff, clients, families and community resources.
- Support and model Aspiranet's values, represent the Agency in a professional manner, and abide by the Agency's Professional Code of Ethics.
- Follow all HIPAA compliance guidelines to ensure the confidentiality of all client information at all times.
- Perform other duties as deemed necessary for the fulfillment of program requirements.
Education and Work Experience:
- High School Diploma/GED; plus two years’ relevant work experience.
- Preferred experience with LACDMH policies and procedures.
- Preferred experience with Medi-Cal eligibility and billing and billing within the LACDMH Contract(s).
- Experience working in EHRS, EXYM highly preferred.
- Proficient in Microsoft Office Suite; Outlook, Word, Excel
- Strong written and oral communication skills; ability to analyze and interpret data, and to effectively communicate.
- Flexibility to manage the assigned workload in order to meet task deadlines.
- Ability to prioritize multiple tasks; detail-oriented, attentive, organized and able to follow directions.
- Experience and knowledge operating and maintaining standard office equipment such as a copier, and printer.
- Meets all state required conditions of employment as set forth by Community Care Licensing for a Licensed Community Care facility; i.e. Fingerprint and Child Abuse.
- Index clearance, TB/Health Physical, valid Driver's License and clean driving record.
- Meets all compliance requirements of federal, state, and county regulations by periodic sanction checks.
Benefits:
Flexible Time Off
- 13 paid holidays along with 10 vacation and 10 sick days
Comprehensive Healthcare
- Medical, dental and vision plans
- A 100% fully employer paid (premium) medical and dental benefit plan
- TelaDoc® employer paid telehealth program
Flexible Spending Accounts
- Medical and dependent care plans
Retirement Savings
- 403(b) and 401(a) retirement plan with employer contributions
Income Protection
- Life, AD&D, and disability insurance
- Accident, critical illness, and hospital gap plan
Training and Advancement
- Ongoing training & development opportunities
- Advancement opportunities
Employee assistance program
- Free confidential crisis line 24/7 (365 days a year)
- Six (6) face-to-face or telephonic sessions per issue
Other Perks
- Commuter program and mileage reimbursement
- Employee recognition and discount programs
EEO/AA
Aspiranet is proud to be an equal employment opportunity employer; all applicants will be given full consideration under state, local, and federal law.
OUR MISSION
Aspiranet is a one-of-a-kind social service agency dedicated to building a world where all children and youth are loved and cared for, and all families have the resources to thrive. Founded in 1975, our core mission is to help California kids and families. Aspiranet’s services include foster care and adoption family support, residential care, support for youth making the transition from foster care to adulthood, mental and behavioral health services, intensive home-based care, and community-based family resources. We provide services throughout California.
Aspira means hope. We are a network of people bringing hope forward. We look forward to learning what makes you passionate.