Medical Biller - Cal AIM

Summary

The Medical Biller for Cal AIM Services is responsible for accurately billing and processing claims for Enhanced Care Management (ECM), Recuperative Care, Community Supports (CS), detox billing, and other Cal AIM-related services. This role ensures timely claim submission, compliance with DHCS and Managed Care Plan (MCP) requirements, and effective coordination with clinical, administrative, and data teams to support revenue integrity.

• 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)

The Pay Rate for this role is based on several factors including the candidate's experience, qualifications, and internal equity. The initial offer usually falls between the minimum and midpoint of the applicable salary range.
Pay Band N5: $25.71 – $34.06 (Midpoint: $29.65).