BILLING ANALYST II

Billing Analyst II – Job Description

We are currently seeking a highly skilled Billing Analyst II with a solid background in Medi-Cal, Other Health Coverage, and Medicare billing processes, including familiarity with CalAIM. This role requires advanced proficiency in data analysis, SQL, and business intelligence tools such as Power BI. The ideal candidate will be adept at interpreting eligibility statuses, investigating and resolving claims, and delivering insightful reporting to support data-driven decisions. This position is on-site, 24 hours a week only.

Key Responsibilities

• Verify Medi-Cal eligibility bi-monthly for all clients; compile and report on clients with terminated coverage. Covivitas
• Partner with program admissions and management staff to streamline eligibility checks, authorizations, audits, corrections, and claims submissions.
• Conduct weekly reconciliation of program/service data between Welligent and county EHR systems to ensure accuracy and compliance.
• Review, update, and implement billing procedures to comply with local, state, and federal regulations.
• Submit timely weekly billing to the Los Angeles County Department of Mental Health (DMH) and third-party payers using systems such as Welligent, Innovalon, and Availity.
• Track and analyze billing data; manage reports to ensure transparency in claims processing and payments.
• Investigate, track, and resolve denied and voided claims, ensuring timely resolution and reimbursement.
• Review SIFT data for claim accuracy within DMH/IBHIS and Welligent systems.
• Generate and distribute detailed management reports, identifying unfiled, pending, denied, and submitted claims.
• Attend relevant internal and external meetings and trainings to stay updated on policies and best practices.
• Prepare various routine documents and reports using Microsoft Word and Excel, including spreadsheets with pivot tables.
• Continuously enhance claims resolution expertise through professional development.
• Utilize SQL to extract, analyze, and manipulate billing data for deeper insights.
• Develop dashboards and analytics reports using Power BI, highlighting trends, denial patterns, and financial performance.
• Collaborate with leadership to provide actionable reporting and strategic analysis to enhance billing operations.

Required Qualifications

• Minimum 3 years of DMH billing experience.
• Proficient in interpreting Medi-Cal, Other Health Coverage, and Medicare eligibility codes (e.g., A, P, F, C).
• Familiarity with CalAIM initiatives and related updates impacting billing and claims.
• Experience with DMH claiming timelines, including submission deadlines and re-submission protocols.
• Solid understanding of the Medicare appeals process.
• Experience with Avatar SIFT data and staying current with CalAIM updates.
• Strong written and verbal communication skills.
• Proficiency in Microsoft Word, Excel (pivot tables), and SQL.
• Familiarity with Power BI or Tableau for data visualization.
• Knowledge of  Claim Adjustment Reason Codes (CARC),
• Excellent time management, organization, and attention to detail; self-motivated and proactive.

Preferred Qualifications

• Bilingual (Spanish) preferred but not required.
• Experience with Welligent or other EHR systems.
• Background in healthcare collections.
• Typing speed of at least 35 wpm.
• DMH medical record documentation requirements.
• Ability to perform cross-coverage and take on additional duties as needed.

Systems:

Welligent, Covivitas, Availity, Inovalon, DMH Avatar (Sift), Power BI,