Position Summary
The Clubhouse Billing Analyst owns the end-to-end revenue cycle for Clubhouse Services claims submitted under San Diego County's BH-CONNECT Clubhouse Services benefit. This role manages daily bundled-rate claims, eligibility verification, denials, reconciliation, and compliance with DHCS and County of San Diego billing guidance.
This is a hands-on role focused on building and maintaining billing workflows for a new and evolving benefit, partnering closely with program staff to ensure documentation supports every claimed day of service.
Key Responsibilities
- Prepare, scrub, and submit daily bundled-rate claims through the County of San Diego's designated claiming system/EHR and ShortDoyle/MediCal process.
- Apply correct procedure codes, modifiers, place of service, and provider data per BHIN 25009 and County billing manuals.
- Reconcile attendance logs and service documentation against claimable member days before submission.
- Verify Medi-Cal eligibility, aid codes, share-of-cost, other health coverage, and managed care assignment issues.
- Work denials, disallowances, voids, and replacements; reconcile remittances and revenue reports.
- Maintain compliance with HIPAA, 42 CFR Part 2 where applicable, and Medi-Cal program integrity requirements.
- Serve as a billing liaison and help train staff on documentation requirements.
- Support billing workflow buildout, desk procedures, and QA processes.
Requirements & Qualifications
- 3+ years of medical billing experience
- At least 1 year of behavioral health, Medi-Cal, or county Specialty Mental Health Services billing experience
- Working knowledge of Medi-Cal eligibility verification, aid codes, and claim adjudication
- Experience with an EHR/practice management system used for behavioral health claims
- Strong Excel skills, including pivot tables and VLOOKUP/XLOOKUP
- High attention to detail and ability to work independently
- High school diploma or GED required
Preferred Qualifications
- Direct experience billing County of San Diego BHS / ShortDoyle Medi-Cal
- Familiarity with CalAIM, BH-CONNECT, per diem or bundled-rate reimbursement models
- Certified Professional Biller (CPB), CRCR, or equivalent credential
- Experience standing up billing operations for a new program or contract
- Bilingual English/Spanish
Benefits & Perks
- 160 hours of PTO
- 12 paid holidays per year, including birthday and one floating holiday after 1 year
- 4 paid volunteer hours per month
- Bereavement leave, including fur baby bereavement
- 90% employer-paid employee-only medical benefits
- Dental and vision insurance
- FSA / dependent care account
- 401(k) with company match
- Monthly stipend
- Short-term and long-term disability plus AD&D
- Employee assistance program (EAP)
- Employee discounts via Great Work Perks and Perks at Work
- Quarterly in-person events
- Fully remote work within California
- Professional development and internal growth opportunities
Location
California, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 month ago