Clubhouse Billing Analyst
New
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Pacific Health GroupBehavioral Health Billing
State-Wide, California, United States, Monday - Friday 8:30 am - 5 pmFull-TimeMiddle
Salary$24 – $26 per hour
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Job Details
- Experience
- 3+ years of medical billing experience, with at least 1 year in behavioral health, MediCal, or county Specialty Mental Health Services (SMHS) billing.
- Required Skills
- Microsoft ExcelEHRHIPAA
Requirements
- 3+ years of medical billing experience, with at least 1 year in behavioral health, MediCal, or county Specialty Mental Health Services (SMHS) billing.
- Strong working knowledge of MediCal eligibility verification, aid codes, and 837/835 claim adjudication processes.
- Experience with behavioral health EHR/practice management systems such as SmartCare, Cerner/CCBH, or Netsmart.
- Advanced Excel proficiency, including pivot tables and VLOOKUP/XLOOKUP.
- High level of attention to detail and ability to work independently in a dynamic regulatory environment.
- High school diploma or GED.
- Preferred: Experience billing County of San Diego BHS/ShortDoyle MediCal.
- Preferred: Familiarity with CalAIM, BHCONNECT, or psychosocial rehabilitation/Clubhouse models.
- Preferred: Certification as a Professional Biller (CPB), CRCR, or equivalent.
- Preferred: Experience standing up billing operations for new programs.
Responsibilities
- Prepare, scrub, and submit daily bundled rate claims for Clubhouse Services using County and DHCS claiming systems.
- Verify MediCal eligibility and aid codes monthly to ensure compliant claiming.
- Perform root-cause analysis on claim denials, disallowances, and voids/replacements, resubmitting corrections within required timeframes.
- Reconcile attendance logs and service documentation against claimable member days.
- Monitor DHCS and County claiming updates and ensure billing adheres to HIPAA and MediCal program integrity requirements.
- Prepare monthly revenue reconciliation reports for leadership.
- Train program staff on documentation elements necessary to support the daily bundled rate.
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