[Hiring] Billing Analyst @Pacific Health Group

Role Description

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 is responsible for:

• Translating daily member attendance and service documentation into clean, compliant claims.
• Managing eligibility, denials, and reconciliation.
• Serving as the billing subject matter expert on DHCS BH-CONNECT claiming guidance.

This is a hands-on role for a billing professional who is comfortable operating in a new benefit with evolving guidance.

Essential Duties and Responsibilities

• Claims Production & Submission:
  • Prepare, scrub, and submit daily bundled rate claims for Clubhouse Services.
  • Apply correct procedure codes, modifiers, place-of-service, and rendering/billing provider data.
  • Reconcile daily Clubhouse attendance logs and service documentation against claimable member days.
  • Track and comply with timely filing requirements and County claim submission calendars.
• Eligibility & Authorization:
  • Verify MediCal eligibility and aid codes for all Clubhouse members monthly.
  • Coordinate resolution of eligibility discrepancies with program staff and County BHS.
• Denials, Corrections & Reconciliation:
  • Work claim denials, disallowances, and voids/replacements.
  • Reconcile remittances against submitted claims.
  • Prepare monthly revenue reconciliation reports for leadership.
• Compliance & Audit Readiness:
  • Maintain working knowledge of BHCONNECT Clubhouse Services requirements.
  • Understand the Clubhouse International Accreditation requirement.
  • Support internal charter-claim audits and respond to County/DHCS audit requests.
  • Ensure all billing activity complies with HIPAA and MediCal program integrity requirements.
• Cross-Functional Support:
  • Serve as the billing liaison to County of San Diego BHS billing/fiscal contacts.
  • Train Clubhouse program staff on documentation elements required to support the daily bundled rate.
  • Assist with billing workflow buildout, desk procedures, and QA processes.

Qualifications

• 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.
• Experience with an EHR/practice management system used for behavioral health claims.
• Strong Excel skills for reconciliation and reporting.
• 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 MediCal.
• Familiarity with CalAIM, BHCONNECT, 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.

Compensation & Benefits

• Hourly range: $24 – $26
• 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
• 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

Work Environment

• Remote
• Monday - Friday 8:30 am - 5 pm

Equal Employment Opportunity

Pacific Health Group is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, ancestry, age, disability, medical condition, genetic information, marital status, military or veteran status, or any other characteristic protected by federal, state, or local law.