Job Description

Job Title: Medical Biller / Authorization & Administrative Support

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Experience Level: 2+ Years

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Location: Vadodara, Gujarat, India / WFH

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Shift Time: US Shift (10-hour shift including a 1-hour break)

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Experience Required

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- Minimum 2+ years of hands-on experience in medical billing, preferably within Medi-Cal managed care, behavioral health, or social services billing.
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- Hands-on experience with Office Ally for claims submission, eligibility verification, and ERA/EOB retrieval is strongly preferred.
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- Experience billing to IEHP or California Medi-Cal managed care plans will be an added advantage.
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- Familiarity with CalAIM Community Supports , including HTNS, HTSS, or similar services, is preferred.
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Key Responsibilities

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- Prepare, review, and submit HTNS and HTSS claims through the Office Ally clearinghouse, ensuring accurate coding, units, authorization numbers, and member eligibility.
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- Monitor clearinghouse reports daily to identify claim acceptance, rejections, and required corrections.
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- Track claims from submission through adjudication and follow up on pending, denied, or underpaid claims.
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- Reconcile remittance advices (835s/EOBs) against expected reimbursement and accurately post payments and adjustments.
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- Research and resolve claim denials by identifying root causes such as authorization mismatches, eligibility gaps, and coding errors.
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- Maintain and update reauthorization trackers to ensure services are billed within active authorization periods.
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- Verify member Medi-Cal/IEHP eligibility prior to billing and flag discrepancies to the appropriate internal team.
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- Maintain accurate, organized, and audit-ready billing records in compliance with HIPAA and applicable privacy requirements.
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- Prepare weekly and monthly billing reports covering aging claims, denial trends, and collections.
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- Stay updated on IEHP authorization guidelines, CalAIM billing requirements, and Office Ally system updates.
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- Collaborate with internal teams to resolve documentation and authorization issues affecting billing.
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Authorization & Administrative Support

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- Monitor and process incoming faxes on a daily basis.
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- Access the IEHP provider portal to retrieve recent authorizations.
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- Enter and update authorization numbers accurately in the relevant tracking systems.
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- Save authorization documents and related files in the designated shared drive according to filing standards.
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- Assign new members and authorizations to the appropriate Case Manager.
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- Review the reauthorization tracker regularly with the supervisor and ensure timely follow-up.
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- Submit completed and supervisor-approved reauthorization requests through the IEHP provider portal.
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- Maintain accurate documentation and complete administrative activities in a timely and organized manner.
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Required Knowledge & Skills

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- Strong understanding of the medical billing and revenue cycle process .
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- Working knowledge of Medi-Cal managed care billing and IEHP processes .
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- Hands-on knowledge of Office Ally for claims processing and eligibility verification.
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- Understanding of claims submission, rejection management, denial follow-up, payment posting, and reconciliation.
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- Knowledge of HIPAA privacy and security requirements and ability to handle PHI appropriately.
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- Strong Excel skills for claim tracking, payment reconciliation, and reporting.
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- Excellent attention to detail and strong organizational skills.
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- Ability to manage high-volume billing activities while maintaining accuracy.
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- Strong written and verbal communication skills for communication with payer representatives and internal teams.
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Preferred Qualifications

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- High school diploma or equivalent required; Associate's degree or medical billing/coding certification preferred.
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- Certified Professional Biller (CPB) or similar billing certification is an added advantage.
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- Experience with Google Workspace (Sheets, Drive) in a HIPAA-compliant environment.
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- Experience with claims scrubbing, denial management workflows, or revenue cycle management software.
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- Experience with behavioral health, community support, or social services billing is preferred.
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- Ability to work independently with minimal supervision while maintaining productivity, accuracy, and compliance.
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Interested candidates can share their CV at [email protected].

📌 Medical Biller (Vadodara)
🏢 Office Beacon
📍 Vadodara