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 authoriz

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