Program Assistant/ Biller

Role overview

Billing and claims

• Verify Medi-Cal and managed-care eligibility daily; prepare and submit accurate, timely claims for ECM and Community Supports.
• Use appropriate billing codes and CalAIM standards; monitor submissions and resolve rejected, denied, or pending claims.

Authorizations and payments

• Track Treatment Authorization Requests and ensure billed services have valid documentation and approved authorizations.
• Coordinate missing-document follow-up; post and reconcile payments; resolve underpayments, denials, and reimbursement delays.
• Maintain accurate billing and financial records.

Compliance and reporting

• Stay current on DHCS, Medi-Cal, and managed-care billing requirements; audit service documentation for compliance.
• Prepare audit and compliance materials, maintain billing logs and submission reports, and report financial performance.
• Analyze trends and recommend improvements to billing efficiency and reimbursement.

Coordination and member support

• Collaborate with case managers, Community Supports providers, and finance staff; educate program staff on billing and documentation.
• Contact health plans to resolve claim issues; make assigned member calls and document outreach in the EHR for case-manager follow-up.
• Attend directed training and meetings and protect client and staff confidentiality.

Minimum requirements

• High school diploma or GED required; one year of related office experience preferred.
• EHR, database, or billing-system experience is preferred but not required.
• Strong computer skills, including Outlook, Word, Excel, and ability to learn software; valid driver's license and qualifying insurance or driving record required.
• State-required physical examination, current tuberculosis test, fingerprint and criminal-record clearance are required before starting.
• Requires organization, accuracy, confidentiality, writing and presentation ability, basic arithmetic, and use of routine accounting principles.
• Nonprofit fund-accounting and budget-development familiarity is desirable.

Pay and schedule

• Pay is $22.50–$28.71 per hour; expected hours are 40 per week.
• Benefits include 403(b), dental, employee assistance, health and vision insurance, paid time off, and retirement plan.

Workplace

• Work location is in person.