CalAIM Billing & Accounts Receivable (AR) Specialist

About the role

The CalAIM Billing & Accounts Receivable (AR) Specialist supports the revenue cycle through accurate billing, claims follow-up, denial management, and accounts receivable resolution.

Responsibilities

• Prepare, review, and submit clean claims to Medi-Cal, commercial payers, and managed care plans.
• Submit and track claims to MCPs; verify authorizations; resolve denials related to medical necessity, prior authorizations, referrals, and program eligibility; and prepare professional appeal letters and retro-authorization requests when applicable.
• Accurate charge entry, payment posting, and adjustments; reconcile remittances (ERA/EOBs); and maintain precise documentation in EMR and billing systems.
• Monitor accounts receivable aging by payer and program, identify denial trends, and escalate root causes with clear and actionable summaries.
• Respond to billing inquiries from patients, providers, and MCPs in a professional, accurate, and timely manner.

Requirements

• 3+ years of medical billing/AR follow up experience in a healthcare setting.
• Proven proficiency with Medi Cal managed care and commercial payers’ claim workflows.
• Track record resolving denials, submitting appeals, and obtaining/correcting authorizations.
• Proficiency with EMR/EHR and billing systems; strong Excel skills (filters, sorting, lookups).
• Exceptional attention to detail, organization, and written communication.

Preferred Qualifications

• Direct CalAIM experience (for example, ECM/CS or other CalAIM benefits), MCP portal submissions, and authorization management preferred.
• Home health or community-based services billing experience preferred.