Job description

We all face challenges and transitions in our lives, and when we do, we must be able to count on the strength of community for support. For the people of Los Angeles, Jewish Family Service LA (JFSLA) is that trusted source of support. We are a comprehensive network of services that welcomes individuals and families of all ages and identities to our full spectrum of care. Our highly trained staff and volunteers work closely with individuals and their loved ones to problem-solve and guide them on their paths to safety, security, wellness, and fulfillment.
JFSLA staff share in our mission and work towards our goals with the highest level of responsibility, professionalism, and integrity. JFS demonstrates our commitment to our staff by offering a comprehensive benefits package and a nurturing environment.
JFSLA is committed to cultivating and preserving a culture of inclusion and connectedness. In recruiting for our team, we seek the unique contributions that individuals can bring from all backgrounds. We strive for a diverse team in order to better serve our clients and ensure our excellence as an organization in identifying, designing and delivering solutions.

Be part of our commitment and join our family. For more information on our philosophy and services, please tour our website www.jfsla.org

Client and Claims Account Specialists’ primary responsibilities are to accurately maintain the client’s healthcare records to submit claims, monitor, analyze, correct, and resubmit to healthcare payors to adjudicate these claims successfully. Responsibilities also include verification of clients’ healthcare benefits and eligibility to determine the correct payor sequence for claim resubmission. The claim specialist will also provide client account management and reporting support to JFS Programs, including the LA County Department of Mental Health (LACDM), The Multipurpose Senior Services Program (MSSP) Waiver program, and Home and Community-Based Services (CBAS) by maintaining databases and generating reports as needed

Qualifications:

• 2 years’ experience with medical billing preferred
• Familiar with the healthcare claim payors, including third-party payors; preferably in behavioral health reimbursement, ICD-10, CPT-4 coding principles, CMS-1500 and UB04
• Knowledge of an Electronic Health Record System (EHRS) used in healthcare for billing clinical services either with standard medical practice billing software or web-based billing software, clearinghouse
• Knowledgeable of the Noridian Medicare Portal, Medi-Cal and several HMO portals
• Skilled in deductive reasoning, data analysis, problem-solving, multi-tasking, completing repetitive tasks with accuracy, and improvising with a creative approach to problems and obstacles
• Communication skills via phone and email to request, collect, organize, and reconcile critical client information and to resolve billing issues with insurance payers
• Familiar with government funding reporting processes such as Medi-Cal and Medicare and Private Insurance.
• Los Angeles County of Mental Health (LACDMH) experience preferred with prior knowledge of IBHIS
• Knowledge of MSSP Program is preferred but not required
• Knowledge of Office 365, OneDrive and SharePoint and moderate proficiency in excel is required
• Able to work independently and take the initiative to solve problems, be part of a team and possess good time management skills to prioritize daily tasks
• Customer service-oriented with solid interpersonal skills, skilled in professional verbal & written communication
• Culturally sensitive and possess the ability to communicate effectively with a multicultural client/customer population and promote favorable interaction with managers, co-workers, and others
• Demonstrates sound judgment and maintains professional boundaries and confidentiality
• Must pass a criminal background check (Live Scan fingerprinting) prior to beginning employment

Responsibilities/Essential Functions:

• Data entry in billing software and applicable agency databases to set up new clients.
• Enroll and process new providers on the Noridian Medicare Portal on behalf of the agency.
• Verify client eligibility and benefits online or by calling insurance (Medi-Cal, Medicare, Private Insurance Coverage: HMO, PPO, HSA, etc.) and be able to distinguish their primary coverage, secondary, and tertiary when applicable
• Review client eligibility verification results/reports and take appropriate follow-up action to ensure the correct payor is billed when resubmitting the claim; this may include working with the clinical supervisor, client, or another department to follow up with results found
• Verify that services provided and purchased for clients fall within limits specified by health care coverage or funding sources
• Generate and transmit billing/invoicing/reports from the EHR system, including private insurance, Medicare, Medi-Cal, LACDMH, and other health care contracts
• Generate extracts from the EHR system for billing, invoicing and reporting
• Receive and post client claims payment and monitor its status and resolve billing issues (unbilled, unpaid, denied, overpayment, voids, incorrectly billed, etc.)
• Independently monitor, analyze, identify, report, categorize, and investigate claim denial patterns and trends to assist the agency in continuously improving/reducing the denial rates (as a % of claims submitted), working with providers and appropriate team members to improve these rates
• Consult with Billing and Team Supervisors and Program Directors and supervisors regarding recurring issues and escalate resolution to appropriate departments as needed
• Other duties as assigned

Jewish Family Service is proud to provide equal employment opportunities to all employees and qualified applicants without regard to race, color, religion, sex, sexual orientation, national or ethnic origin, age, disability or status as a veteran.

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Job Type: Full-time

Pay: $22.48 - $33.72 per hour

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