Director of Medi-Cal Billing

CARDEA HEALTH•Oakland, CA

1d•Hybrid

About The Position

The Director of Medi-Cal Billing is a strategic and operational leader responsible for overseeing all aspects of Cardea Health’s Medi-Cal billing, enrollment, and revenue optimization functions. This role ensures the financial sustainability of programs by maximizing reimbursement, reducing denials, and building scalable billing infrastructure to support organizational growth. Reporting to the CEO, this leader partners closely with Finance, Clinical, Compliance, and Program leadership to align billing operations with evolving Medi-Cal requirements and new program implementation. This role requires a highly driven, solutions-oriented leader who is relentlessly persistent in resolving billing challenges, navigating payer systems, and ensuring payment for services delivered.

Requirements

Deep expertise in Medi-Cal billing, including managed care and fee-for-service environments
5–8+ years of progressive experience in medical billing/revenue cycle, including leadership experience
Proven success optimizing billing operations and increasing reimbursement rates
Strong analytical, problem-solving, and systems-thinking skills
Demonstrated ability to navigate complex payer systems with persistence and urgency
Experience managing teams and building scalable processes in a growing organization

Nice To Haves

Experience in nonprofit, community health, or services for high-acuity populations
Familiarity with California waiver programs and housing-based healthcare models
Experience billing Medi-Cal waiver programs (HCBA, ALW, CalAIM including housing community supports and enhanced care management)
Experience implementing billing for new programs or service lines
Bachelor’s degree in Healthcare Administration, Business, or related field (Master’s preferred)

Responsibilities

Develop and execute a comprehensive Medi-Cal billing and revenue cycle strategy aligned with organizational growth goals
Identify and implement opportunities to improve reimbursement, reduce denials, and accelerate cash flow
Lead billing readiness and infrastructure development for new programs, services, and contracts
Serve as internal subject matter expert on Medi-Cal billing (FFS, managed care, waivers, TARs, etc.)
Lead, develop, and scale the Medi-Cal billing team, including billers and enrollment staff
Establish performance metrics, workflows, and accountability systems to ensure high-functioning operations
Foster a culture of persistence, ownership, and continuous improvement
Step into operational workflows as needed to resolve complex issues or bottlenecks
Oversee all billing functions, including: Treatment Authorization Requests (TARs), Claims submission (Medi-Cal and managed plans), Eligibility tracking and enrollment, Denials management and appeals
Ensure timely, accurate submission and follow-up on all claims
Drive aggressive follow-up strategies to minimize outstanding receivables
Ensure compliance with all Medi-Cal billing regulations and documentation requirements
Partner with Compliance and Finance on audits, reporting, and regulatory readiness
Support contracting and billing alignment with key partners (e.g., Alameda County, managed care plans)
Maintain readiness for external audits, reviews, and payer inquiries
Partner with clinical and program teams to ensure documentation supports billing requirements
Work with Finance to ensure accurate revenue recognition and forecasting
Advise leadership on billing implications of program design and expansion