Clubhouse Billing Analyst

Position Summary

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 involves preparing, scrubbing, and submitting daily bundled rate claims, verifying MediCal eligibility, handling denials and corrections, and supporting internal audits.

Essential Duties And Responsibilities

• 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 rootcause 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.
• 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.
• Aid in billing workflow buildout, desk procedures, and QA processes for this new service line; support billing for other PHG lines of business as capacity allows.

Minimum 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 (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.

Preferred Qualifications

• Direct experience billing County of San Diego BHS / ShortDoyle MediCal.
• Familiarity with CalAIM, BHCONNECT, per diem or bundled rate reimbursement models, or psychosocial rehabilitation programs (Clubhouse model a plus).
• Certified Professional Biller (CPB), CRCR, or equivalent credential.
• Experience standing up billing operations for a new program or contract.