Billing Analyst

Pacific Health Group

Clubhouse Billing Analyst at Pacific Health Group managing end-to-end revenue cycle for Clubhouse Services claims. Ensuring compliance and managing billing processes in a rapidly evolving landscape.

Posted 7/8/2026full-timeRemote • California • 🇺🇸 United StatesMid-LevelSenior💰 $24 - $26 per hourWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claim AdjudicationReconciliationDocumentation StandardsRoot-Cause AnalysisClaim SubmissionBilling ComplianceData SubmissionRevenue ReconciliationEligibility Discrepancy ResolutionBundled Rate Structure

Soft Skills

Attention to DetailIndependent WorkTraining and Support

Certifications

Certified Professional Biller (CPB)CRCR