Job Title: Medical Biller / Authorization & Administrative Support

Experience Level: 2+ Years

Location: Vadodara, Gujarat, India / WFH

Shift Time: US Shift (10-hour shift including a 1-hour break)

Experience Required

Minimum 2+ years of hands-on experience in medical billing, preferably within Medi-Cal managed care, behavioral health, or social services billing.
Hands-on experience with Office Ally for claims submission, eligibility verification, and ERA/EOB retrieval is strongly preferred.
Experience billing to IEHP or California Medi-Cal managed care plans will be an added advantage.
Familiarity with CalAIM Community Supports, including HTNS, HTSS, or similar services, is preferred.

Key Responsibilities

Prepare, review, and submit HTNS and HTSS claims through the Office Ally clearinghouse, ensuring accurate coding, units, authorization numbers, and member eligibility.
Monitor clearinghouse reports daily to identify claim acceptance, rejections, and required corrections.
Track claims from submission through adjudication and follow up on pending, denied, or underpaid claims.
Reconcile remittance advices (835s/EOBs) against expected reimbursement and accurately post payments and adjustments.
Research and resolve claim denials by identifying root causes such as authorization mismatches, eligibility gaps, and coding errors.
Maintain and update reauthorization trackers to ensure services are billed within active authorization periods.
Verify member Medi-Cal/IEHP eligibility prior to billing and flag discrepancies to the appropriate internal team.
Maintain accurate, organized, and audit-ready billing records in compliance with HIPAA and applicable privacy requirements.
Prepare weekly and monthly billing reports covering aging claims, denial trends, and collections.
Stay updated on IEHP authorization guidelines, CalAIM billing requirements, and Office Ally system updates.
Collaborate with internal teams to resolve documentation and authorization issues affecting billing.

Authorization & Administrative Support

Monitor and process incoming faxes on a daily basis.
Access the IEHP provider portal to retrieve new authorizations.
Enter and update authorization numbers accurately in the relevant tracking systems.
Save authorization documents and related files in the designated shared drive according to filing standards.
Assign new members and authorizations to the appropriate Case Manager.
Review the reauthorization tracker regularly with the supervisor and ensure timely follow-up.
Submit completed and supervisor-approved reauthorization requests through the IEHP provider portal.
Maintain accurate documentation and complete administrative activities in a timely and organized manner.

Required Knowledge & Skills

Strong understanding of the medical billing and revenue cycle process.
Working knowledge of Medi-Cal managed care billing and IEHP processes.
Hands-on knowledge of Office Ally for claims processing and eligibility verification.
Understanding of claims submission, rejection management, denial follow-up, payment posting, and reconciliation.
Knowledge of HIPAA privacy and security requirements and ability to handle PHI appropriately.
Strong Excel skills for claim tracking, payment reconciliation, and reporting.
Excellent attention to detail and strong organizational skills.
Ability to manage high-volume billing activities while maintaining accuracy.
Strong written and verbal communication skills for communication with payer representatives and internal teams.

Preferred Qualifications

High school diploma or equivalent required; Associate's degree or medical billing/coding certification preferred.
Certified Professional Biller (CPB) or similar billing certification is an added advantage.
Experience with Google Workspace (Sheets, Drive) in a HIPAA-compliant environment.
Experience with claims scrubbing, denial management workflows, or revenue cycle management software.
Experience with behavioral health, community support, or social services billing is preferred.
Ability to work independently with minimal supervision while maintaining productivity, accuracy, and compliance.

Interested candidates can share their CV at [HIDDEN TEXT].