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Company : Pacific Health Group Department : Revenue Cycle / Billing FLSA Status : Non-Exempt, Full-Time Pay Range : $24 – $26 per hour  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. Unlike traditional fee-for-service behavioral health billing, Clubhouse Services is reimbursed through a county-specific daily bundled (per diem) rate claimed through the county SMHS delivery system. This role is responsible for translating daily member attendance and service documentation into clean, compliant claims; managing eligibility, denials, and reconciliation; and serving as the billing subject matter expert on DHCS BH-CONNECT claiming guidance (including BHIN 25009, the BH-CONNECT EBP Policy Guide, and County of San Diego Behavioral Health Services billing requirements). This is a hands-on role for a billing professional who is comfortable operating in a new benefit with evolving guidance — building billing workflows from the ground up, monitoring DHCS and County claiming updates, and partnering closely with program staff to make sure documentation supports every claimed day of service. Essential Duties and Responsibilities Claims Production & Submission  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. Eligibility & Authorization  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. Denials, Corrections & Reconciliation  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. Compliance & Audit Readiness  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. Cross-Functional Support  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 suppo