Pacific Health Group logo
Pacific Health Group

Your Life’s Partner through the Journey of Wellness

Billing Analyst

Billing SpecialistBilling SpecialistFull TimeRemoteSeniorTeam 51-200Since 2023H1B No SponsorCompany SiteLinkedIn

Location

California

Posted

3 days ago

Salary

$24 - $26 / hour

Seniority

Senior

High School3 yrs expEnglish

Job Description

Billing Analyst

Pacific Health Group

• Prepare, scrub, and submit daily bundled rate claims for Clubhouse Services through the County of San Diego's designated claiming system/EHR and ShortDoyle/MediCal process, in accordance with County and DHCS requirements. • Apply correct procedure codes, modifiers, place-of-service, and rendering/billing provider data per BHIN 25009, the BH-CONNECT EBP Policy Guide, and County billing manuals. • Reconcile daily Clubhouse attendance logs and service documentation against claimable member days before submission; flag undocumented or unsupported days to program leadership prior to claiming. • Track and comply with timely filing requirements and County claim submission calendars. • Verify MediCal eligibility and aid codes for all Clubhouse members monthly (and prior to claiming), including share-of-cost, other health coverage (OHC), and managed care assignment issues that affect SMHS claiming. • Coordinate resolution of eligibility discrepancies with program staff and County BHS as needed. • Work claim denials, disallowances, and voids/replacements; perform root-cause analysis and correct/resubmit within required timeframes. • Reconcile remittances (835s/EOBs) against submitted claims; maintain accurate accounts receivable aging and escalate underpayments or unpaid claims. • Prepare monthly revenue reconciliation reports (claimed vs. paid vs. expected at the County bundled rate) for leadership. • Maintain working knowledge of BHCONNECT Clubhouse Services requirements, including the daily bundled rate structure, medical necessity/eligibility criteria, and documentation standards; monitor DHCS BHINs and County BHS updates for claiming changes. • Understand the Clubhouse International Accreditation requirement and its impact on claiming eligibility (MediCal claiming is limited to four years total prior to Accreditation); support leadership in tracking accreditation-linked billing status. • Support internal charter-claim audits and respond to County/DHCS audit requests, recoupments, and cost report or data submissions as assigned. • Ensure all billing activity complies with HIPAA, 42 CFR Part 2 (where applicable), and MediCal program integrity requirements; report suspected compliance issues immediately. • Serve as the billing liaison to County of San Diego BHS billing/fiscal contacts for Clubhouse Services claiming questions. • Train Clubhouse program staff on documentation elements required to support the daily bundled rate. • Assist with billing workflow buildout, desk procedures, and QA processes for this new service line; support billing for other PHG lines of business as capacity allows.

Job Requirements

  • 3+ years of medical billing experience, with at least 1 year in behavioral health, MediCal, or county Specialty Mental Health Services (SMHS) billing.
  • Working knowledge of MediCal eligibility verification, aid codes, and claim adjudication (837/835 transactions, denial codes, void/replace processes).
  • Experience with an EHR/practice management system used for behavioral health claims (e.g., SmartCare, Cerner/CCBH, Netsmart, or comparable).
  • Strong Excel skills (pivot tables, VLOOKUP/XLOOKUP or equivalent) for reconciliation and reporting.
  • High attention to detail, documentation discipline, and ability to work independently in a program with new and evolving guidance.
  • High school diploma or GED required.
  • Direct experience billing County of San Diego BHS / ShortDoyle MediCal (preferred).
  • Familiarity with CalAIM, BHCONNECT, per diem or bundled rate reimbursement models, or psychosocial rehabilitation programs (Clubhouse model a plus) (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

  • 160 Hours of Paid Time Off (PTO)
  • 12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment
  • 4 Paid Volunteer Hours per Month to support causes you care about
  • 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 & Long-Term Disability | 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
  • Opportunities for professional development and internal growth

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