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Clubhouse Billing Analyst

2 months, 2 weeks ago
Remote
Full-time
Junior
Accountant
Operations
HIPAA
Apply Now
Pacific Health Group

Pacific Health Group

Pacific Health Group Your Life's Partner through the Journey of Wellness Your Healthcare Concierge Housing and Community Services Family, Individual & Couples Therapy Transportation services at your finger tips Your Healthcare Concierge Housing and Com...

Health Care Providers & Services
1-10
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Description

  • Prepare, scrub, and submit daily bundled rate claims through the County of San Diego claiming system and ShortDoyle/MediCal process.
  • Apply the correct procedure codes, modifiers, place-of-service, and provider data according to County and DHCS guidance.
  • Reconcile daily attendance logs and service documentation against claimable member days before submission.
  • Track timely filing requirements and county claim submission calendars.
  • Verify Medi-Cal eligibility, aid codes, share-of-cost, other health coverage, and managed care assignment issues affecting claims.
  • Coordinate resolution of eligibility discrepancies with program staff and County BHS as needed.
  • Work claim denials, disallowances, voids, and replacements, including root-cause analysis and resubmission.
  • Reconcile remittances against submitted claims and maintain accurate accounts receivable aging.
  • Prepare monthly revenue reconciliation reports showing claimed, paid, and expected amounts.
  • Monitor BH-CONNECT, DHCS, and County billing updates, support audits, and ensure HIPAA and program integrity compliance.
  • Serve as the billing liaison to County BHS contacts and train program staff on documentation requirements.
  • Assist with building billing workflows, desk procedures, and QA processes for the new service line.

Requirements

  • 3+ years of medical billing experience, including at least 1 year in behavioral health, Medi-Cal, or county Specialty Mental Health Services billing.
  • Working knowledge of Medi-Cal eligibility verification, aid codes, and claim adjudication processes, including 837/835 transactions, denial codes, and void/replace workflows.
  • Experience with an EHR or practice management system used for behavioral health claims, such as SmartCare, Cerner/CCBH, Netsmart, or a comparable platform.
  • Strong Excel skills, including pivot tables and VLOOKUP/XLOOKUP or equivalent functions.
  • High attention to detail, documentation discipline, and ability to work independently in a program with evolving guidance.
  • High school diploma or GED required.
  • Direct experience billing County of San Diego BHS / ShortDoyle Medi-Cal preferred.
  • Familiarity with CalAIM, BH-CONNECT, per diem or bundled rate reimbursement models, or psychosocial rehabilitation programs preferred.
  • Certified Professional Biller (CPB), CRCR, or equivalent credential preferred.
  • Experience standing up billing operations for a new program or contract preferred.
  • Bilingual English/Spanish preferred.

Benefits

  • Hourly pay range of $24 to $26.
  • 160 hours of paid time off.
  • 12 paid holidays per year, including your birthday and one floating holiday after 1 year.
  • 4 paid volunteer hours per month.
  • 90% employer-paid employee-only medical benefits.
  • Dental and vision insurance, plus FSA and dependent care account options.
  • 401(k) with company match.
  • Monthly stipend, short-term and long-term disability, AD&D, and employee assistance program.
  • Fully remote work within California, with Monday through Friday hours.
  • Opportunities for professional development and internal growth.

Interested in this position?

Apply directly on the company website

Apply Now

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