Medical Biller

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].