Note: The job is a remote job and is open to candidates in USA. Compass Family Services is a nonprofit organization dedicated to assisting San Francisco families who are homeless or at-risk of homelessness. They are seeking a Medi-Cal Billing Infrastructure Consultant to guide the development of their billing infrastructure for behavioral health services, ensuring compliance and optimizing revenue opportunities.
Responsibilities
- Conduct a series of analyses and produce key deliverables, including service billing feasibility, billing pathway comparison, and EHR system recommendations
- Assess the Medi-Cal eligibility rate among current CBHS clients and map CBHS services to billable Medi-Cal benefit categories
- Produce a revenue model with low, mid, and high scenarios that validates or revises internal projections of billing revenue
- Identify which CBHS services are billable under standard outpatient Medi-Cal codes and advise on handling non-billable services
- Assess the financial, administrative, and logistical considerations involved in billing through a third-party entity as compared to billing Medi-Cal directly
- Advise on EHR requirements from a Medi-Cal billing and compliance standpoint
- Review findings from the internal readiness audit and advise on critical gaps to address before billing begins
- Participate in contract negotiation with a third-party billing partner and advise on considerations for billing setup
- Advise on denial pattern analysis, documentation improvement, and workflow optimization as billing begins
- Support development of billing compliance policies, utilization review processes, audit readiness procedures, and privacy protocols to Medi-Cal standards
- Provide direct support in preparing and submitting the certification application to the county MHP or applicable health system
- Advise on how to integrate the internal Salesforce database with a new EHR
- Assist in preparing and administering staff training
Skills
- Deep working knowledge of the California Medi-Cal behavioral health system
- Experience with community-based nonprofit providers
- Ability to work practically and collaboratively with an internal team new to Medi-Cal
- Experience with behavioral health billing
- Experience with nonprofit community-based organizations serving similar populations
- Practical orientation — evidence that the consultant can work effectively with the Compass team
- Specific experience with California Medi-Cal
- Familiarity with San Francisco behavioral health landscape
- Experience with county MHP contracting
Company Overview
To help homeless families and families at imminent risk for homelessness to achieve housing stability & family well-being It was founded in 1914, and is headquartered in San Francisco, California, USA, with a workforce of 51-200 employees. Its website is http://compass-sf.org/.