Revenue Cycle Manager

South Coast Community Services; Placentia (CA); In loco; USD 90.000 - 125.000; Tempo pieno

Descrizione del lavoro

South Coast Community Services seeks an experienced Billing Leader to own the full revenue cycle for the FSP-HFW program, from eligibility through payment and final settlement with the County.

You will lead Medi-Cal FFS billing, denial management, and monthly reporting, ensuring COB priorities and accurate E&R filings while coordinating with IT/EHR for setup and data exchanges.

Competenze

• Bachelor degree or equivalent experience in a related field.
• Minimum 5 years in healthcare billing with 3 years in CA Medi-Cal SMHS or behavioral health.
• Experience supervising staff and managing contracts or budgets.

Mansioni

• Own the revenue cycle for the FSP-HFW program from eligibility to payment.
• Lead Medi-Cal FFS billing, denial management, and follow-up on unpaid claims.
• Submit monthly County invoicing by the 20th on approved forms.
• Prepare the monthly E&R report within 25 days of month-end.
• Oversee COB so other payers are billed before Medi-Cal.
• Manage Medi-Cal vs BHSA 'Other Funding' split and budget tracking.
• Lead reconciliation/final settlement with County and support audits.
• Coordinate billing setup with IT/EHR (myEvolv) and data exchanges.
• Report billing KPIs monthly to leadership and QA/QI.

Conoscenze

Billing leadership

Healthcare billing

Budgeting & reporting

Staff supervision

CalAIM knowledge

Formazione

Bachelor's degree in accounting, finance, health administration, or related field

Strumenti

myEvolv billing

CPT/HCPCS coding

EDI & claims data exchange

Descrizione del lavoro

Description

POSITION SUMMARY

Owns the whole revenue cycle for the FSP-HFW program, from client eligibility through claim payment, County invoicing, and Reconciliation and Final Settlement. This is the position SCCS names under Exhibit A §J as responsible for managing program funds.

Essential Duties and Responsibilities

• Lead Medi-Cal FFS billing for the program: claim submission, denial management, resubmission, and follow-up on unpaid claims.
• Make sure the monthly County invoice is submitted by the 20th on the County-approved form. Only dates of service on or after October 16, 2026 can be billed.
• Prepare or approve the monthly Expenditure & Revenue (E&R) report, due within 25 calendar days of month-end.
• Oversee Coordination of Benefits so other payers, including Medicare, are billed before Medi-Cal.
• Manage the split between Medi-Cal and BHSA "Other Funding," which pays only for client services that can't be billed to Medi-Cal.
• Track spending against the contract budget and the Not-to-Exceed amount. Flag over- or under-spending and recommend budget or staffing changes to request from the County.
• Lead Reconciliation and Final Settlement with the County, and support audits.
• Keep billing entry structurally separate from clinicians and other direct service staff, as Exhibit A requires.
• Keep the inventory of County IRIS tokens: who has each one by serial number, issuing and returning them, and reporting losses.
• Work with IT/EHR staff on billing setup in myEvolv, SCCS's EHR, EDI and claim files, and data exchanges with the State and County.
• Report billing KPIs every month (clean-claim rate, denial rate, days in A/R, lag from service to claim) to program leadership and the QA/QI program.
• Keep billing policies and procedures current with DHCS Behavioral Health Information Notices (BHINs), the BHSA County Policy Manual, and County billing manuals.

Requirements

Minimum Qualifications

• Bachelor's degree in accounting, finance, health administration, or a related field. Equivalent experience may substitute.
• At least 5 years of healthcare billing experience, with at least 3 in California Medi-Cal Specialty Mental Health Services (SMHS) or behavioral health, and at least 2 supervising staff.
• Working knowledge of CalAIM payment reform, CPT and HCPCS coding for SMHS, CMS-1500 and 837P claims, and County Mental Health Plan billing.
• Experience with nonprofit or government contract budgeting, cost reports, and settlement.

Preferred Qualifications

• CPC, CPB, CRCR, or a similar certification.
• Experience with myEvolv (Netsmart) billing setup and reports.
• Experience with Orange County HCA's IRIS system.
• Experience with Wraparound or FSP programs.

Required Trainings

County BHS New User Training, Annual Provider Training, Annual Compliance Training, and HIPAA/42 CFR Part 2 training.

PHYSICAL REQUIREMENTS:

• Ability to drive a motor vehicle without restrictions, often in heavy traffic and frequently long distances.
• Senses of vision, hearing and smell sufficient to regularly operate a motor vehicle, to visualize threats in the environment or risks to clients, and to operate safely in the field.
• Required to occasionally lift and carry 10-20 pounds.
• Regularly required to sit, stand, climb stairs (1 or more flights) and walk while in route to and during family visits.
• Regularly required to sit and use computer in office settings.

EOE, INCLUDING DISABILITY/VETS

We are an equal opportunity employer and consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, disability, medical condition, genetic information, marital status, veteran status, or any other protected characteristic under California law.

Management reserves the right to add, change, delete or rescind duties or responsibilities of positions within the job classification at any time.