Billing Specialist

Summary

The Billing Specialist is responsible for supporting timely and accurate billing for Care Coordination and Medication Support Services across SMRS residential DMC-ODS programs. The position ensures that eligible services are captured, documentation is finalized and ready for claim submission, and billing requirements are completed in a timely manner. The Billing Specialist works collaboratively with program, clinical, medication support, quality assurance, and finance staff to address billing needs and support an efficient revenue cycle.

Essential Duties and Responsibilities

1.            Review Care Coordination and Medication Support Services in PCNX to verify documentation is finalized, required signatures are present, and services are ready for billing in accordance with applicable agency and billing requirements. Prepare and submit timely claims and service billings through PCNX and applicable Los Angeles County SAPC billing processes.

2.            Monitor claim status, rejections, denials, pending items, and unpaid services; research root causes and complete timely corrections, rebilling, or escalation.

3.            Maintain organized billing work queues, tracking logs, reconciliation reports, and supporting documentation for submitted, corrected, and outstanding claims.

4.            Reconcile billed services to PCNX activity, program records, payment/remittance information, and internal finance reports; identify discrepancies and coordinate resolution.

5.            Communicate clearly with counselors, care coordinators, medication support staff, supervisors, QA staff, and program leadership regarding missing, late, or non-billable documentation.

6.            Provide routine follow-up and technical support to program staff on PCNX billing-related documentation requirements and correction steps within the scope of the role.

7.            Assist with month-end billing close activities, aging follow-up, revenue reporting, and audit preparation.

8.            Maintain the confidentiality and security of protected health information and comply with HIPAA, 42 CFR Part 2, Medi-Cal, Los Angeles County SAPC, and SMRS policies.

9.            Stay current on applicable billing guidance, PCNX workflow changes, service definitions, and internal procedures; participate in required trainings and meetings.

10.          Perform other related billing, data-entry, reconciliation, and administrative duties as assigned.

Language and Communication Skills

1.            Ability to read and write English fluently.

2.            Ability to speak effectively before groups.

3.            Ability to review objectively within the Agency’s electronic health record systems

4.            Detail oriented.

5.            Basic proficiency in using a computer and other telehealth technology. Proficient in Word and Microsoft Office software.

Other Requirements

1.            High school diploma or GED

2.            Knowledge of 12-Step programs and/or philosophy.

3.            Current CPR and First Aid Certifications.

4.            A valid government-issued picture ID.

5.            If employee uses their personal vehicle to commute to work and/or parks on Agency property, a current California driver’s license is required.

a.    If employee has an out-of-state driver’s license, they must attain a valid California license no later than 10 days from employment start date.

b.    Must maintain current liability insurance coverage on personal vehicle.

Social Model Recovery Systems (a non-profit 501(c)3 California corporation) provides direct treatment services (at 11 locations in Los Angeles County) for those whose lives have become unmanageable due to alcohol and other drug use and/or whose mental health issues are interfering with leading productive lives. Thousands of individuals have found help in our programs since 1987. We know that ultimately recovery is a personal choice, but we here at Social Model Recovery Systems are here to assist you in your steps to a healthier lifestyle.

Social Model Recovery Systems is an Equal Opportunity Employer.