Billing Analyst

This is a fully remote position, open to applicants in California.

📋 Description

• Prepare, clean, and submit daily bundled rate claims for Clubhouse Services using the County of San Diego's specified claiming system/EHR and ShortDoyle/MediCal process, in compliance with County and DHCS guidelines.

• Apply the appropriate procedure codes, modifiers, place-of-service, and rendering/billing provider information according to BHIN 25009, the BH-CONNECT EBP Policy Guide, and County billing manuals.

• Reconcile daily Clubhouse attendance logs and service documentation against claimable member days prior to submission; flag any undocumented or unsupported days to program leadership before claiming.

• Monitor and adhere to timely filing requirements and County claim submission schedules.

• Verify MediCal eligibility and aid codes for all Clubhouse members on a monthly basis (and prior to claiming), including share-of-cost, other health coverage (OHC), and managed care assignment issues impacting SMHS claims.

• Coordinate the resolution of eligibility discrepancies with program staff and County BHS as necessary.

• Address claim denials, disallowances, and voids/replacements; conduct root-cause analysis and correct/resubmit within the required timeframes.

• Reconcile remittances (835s/EOBs) against submitted claims; maintain accurate accounts receivable aging and escalate any underpayments or unpaid claims.

• Generate monthly revenue reconciliation reports (claimed vs. paid vs. expected at the County bundled rate) for leadership review.

• Maintain a comprehensive understanding of BHCONNECT Clubhouse Services requirements, including the daily bundled rate structure, medical necessity/eligibility criteria, and documentation standards; keep abreast of DHCS BHINs and County BHS updates regarding claiming changes.

• Understand the Clubhouse International Accreditation requirement and its implications for claiming eligibility (MediCal claiming is restricted to four years total prior to Accreditation); assist leadership in tracking accreditation-linked billing status.

• Assist with internal charter-claim audits and respond to County/DHCS audit requests, recoupments, and cost report or data submissions as assigned.

• Ensure all billing activities adhere to HIPAA, 42 CFR Part 2 (where applicable), and MediCal program integrity standards; immediately report any suspected compliance issues.

• Act as the billing liaison to County of San Diego BHS billing/fiscal contacts for inquiries related to Clubhouse Services claiming.

• Provide training to Clubhouse program staff on the documentation elements necessary to support the daily bundled rate.

• Support the development of billing workflows, desk procedures, and QA processes for this new service line; assist with billing for other PHG lines of business as capacity permits.

⛳️ Requirements

• A minimum of 3 years of medical billing experience, with at least 1 year in behavioral health, MediCal, or County Specialty Mental Health Services (SMHS) billing.

• Proficient knowledge of MediCal eligibility verification, aid codes, and claims adjudication (837/835 transactions, denial codes, void/replace processes).

• Experience with an EHR/practice management system utilized for behavioral health claims (e.g., SmartCare, Cerner/CCBH, Netsmart, or equivalent).

• Strong Excel skills (pivot tables, VLOOKUP/XLOOKUP or similar) for reconciliation and reporting tasks.

• Exceptional attention to detail, documentation discipline, and the capability to work independently in a program with new and evolving guidance.

• High school diploma or GED is required.

• Direct experience with billing for County of San Diego BHS / ShortDoyle MediCal is preferred.

• Familiarity with CalAIM, BHCONNECT, per diem or bundled rate reimbursement models, or psychosocial rehabilitation programs (Clubhouse model experience is a plus) is preferred.

• Certification as a Professional Biller (CPB), CRCR, or equivalent credential is preferred.

• Experience establishing billing operations for a new program or contract is preferred.

• Bilingual in English and Spanish is preferred.

🏝️ Benefits

• 160 Hours of Paid Time Off (PTO)

• 12 Paid Holidays each year, including your birthday and one floating holiday after one year of employment

• 4 Paid Volunteer Hours per Month to support causes you care about

• Bereavement Leave, including for pets

• 90% Employer-covered Employee-Only Medical Benefits

• Dental and Vision Insurance

• FSA | Dependent Care Account

• 401(k) with Company Match

• Monthly Stipend

• Short-Term & Long-Term Disability | AD&D

• Employee Assistance Program (EAP)

• Employee Discounts through Great Work Perks and Perks at Work

• Quarterly In-Person Events

• Fully remote work available within California

• Opportunities for professional development and internal advancement