CalAIM Program Assistant (50700)

• Verify Medi-Cal and managed care eligibility daily.
• Prepare and submit accurate and timely claims to Medi-Cal managed care plans for ECM and CS services.
• Ensure proper use of billing codes and compliance with CalAIM billing standards.
• Monitor claim submissions; track rejections, denials, or pending claims and follow up promptly to resolve issues.

• Track and verify Treatment Authorization Requests (TARs) for all billable services.
• Ensure billed services are supported by valid documentation and approved authorizations.
• Coordinate with program and clinical staff to address missing or incomplete documentation.

• Post payments received from managed care plans and reconcile against submitted claims.
• Investigate and resolve underpayments, denials, or delays in reimbursement.
• Maintain accurate and up-to-date financial and billing records.

• Stay current with DHCS, Medi-Cal, and managed care billing regulations and updates.
• Conduct internal audits of service documentation to ensure billing compliance.
• Prepare and provide necessary reports and documentation for audits, compliance reviews, and internal monitoring.

• Collaborate closely with ECM case managers, CS providers, and finance staff to ensure billing accuracy.
• Educate and guide program staff on documentation and billing requirements.
• Communicate with health plans to resolve discrepancies, denials, or claim issues.

• Maintain accurate billing logs, tracking systems, and submission reports.
• Generate regular billing and financial performance reports for leadership.
• Analyze trends and recommend improvements to enhance billing efficiency and reimbursement rates.

• Conduct routine outbound calls to members, as assigned, to support appointment reminders, eligibility verification, required program follow-up, and other administrative activities that promote member engagement and continuity of services.

• Document member outreach activities in the electronic health record and communicate pertinent information to the assigned Case Manager.
• Attendstrainingandinformationalmeetingsas directed.
•   Maintains confidentiality with respecttoinformation andrecords concerning clients, andstaff.
• Other duties as assignedwithin the scope of position classification.

• High school diploma or GED required.
• One year of experience in an administrative, customer service, medical office, billing, accounting support, or related office environment preferred.
• Experience working with electronic health records (EHR), databases, or billing systems is preferred but not required.
• Strong computer skills, including Microsoft Outlook, Word, Excel, and the ability to learn new software systems.
• State regulations require a physical examination, current tuberculosis test, and verified   

• Possession of a valid drivers' license; current personal vehicle insurance or safe driving record    

• Ability to organize and prioritize multiple tasks while maintaining a high level of accuracy and attention to detail.

• Ability to maintain confidentiality and handle sensitive client and financial information in accordance with HIPAA and agency policies.
• Abilityto writereports, businesscorrespondence,and proceduremanuals.
• Abilitytoeffectively presentinformationandrespondto questionsfromgroups of parents,employees ofthe organization,andthe general public.
• Previousexperienceandfamiliarity with nonprofitfundaccountingandexperiencein budget developmentis desirable.
• Abilityto add, subtract,multiplyand dividein all units ofmeasure, using whole numbers,commonfractionsand decimals.
• Abilityto computerate,ratioand percent.
• Abilityto applygenerallyacceptedaccounting principlesto routineactivities.
• Abilityto understandand use a variety ofcomputerapplicationsandappropriate software,including spreadsheetsand word processing;and workplaceelectronictechnology,includinginternetaccess and email.

Qualifications

• High school diploma or GED required.
• One year of experience in an administrative, customer service, medical office, billing, accounting support, or related office environment preferred.
• Experience working with electronic health records (EHR), databases, or billing systems is preferred but not required.
• Strong computer skills, including Microsoft Outlook, Word, Excel, and the ability to learn new software systems.
• State regulations require a physical examination, current tuberculosis test, and verified fingerprint and criminal records clearance before beginning work.
• Possession of a valid drivers' license; current personal vehicle insurance or safe driving record sufficient to ensure insurability through Agency policy.