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 [Confidential Information].
