Medi-Cal Billing Infrastructure Consultant

Compass Family Services•San Francisco, CA

13d•$30,000 - $100,000•Remote

About The Position

Compass Family Services, a nonprofit organization dedicated to assisting San Francisco families who are homeless or at-risk of homelessness, is seeking an experienced consultant to guide the building of Medi-Cal billing infrastructure for its behavioral health services program (Compass Behavioral Health Services - CBHS). This initiative is a strategic priority to diversify revenue and strengthen the financial foundation for behavioral health services, supported by a four-year Hellman Foundation grant. The ideal partner will have deep knowledge of the California Medi-Cal behavioral health system, experience with community-based nonprofit providers, and the ability to collaborate effectively with an internal team new to Medi-Cal. This is an initial one-year engagement with potential for two additional years based on performance.

Requirements

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.
Resume.
Narrative description of relevant content experience, including specific experience with California Medi-Cal, behavioral health billing, nonprofit community-based providers, and the San Francisco county landscape.
Narrative description of relevant consulting or partnership experience, including a brief description of past projects, your role, what your work entailed, and client achievements.
Proposal for Year 1 scope of work, including how the work would be structured, what would be needed from Compass, availability and capacity, and proposed fee structure for Year 1.
Understanding of the clinical and mission implications of establishing a diagnostic pathway for clients entering the billable track.
Ability to advise on how a mix of licenses (LCSW, LMFT, ASW, AMFT, clinical interns) may affect billing capacity.
Comfort working with a model where Medi-Cal and government funding co-exist.

Nice To Haves

Experience with Federally Qualified Health Centers (FQHCs).
Experience with county behavioral health departments.
Experience with established Medi-Cal certified behavioral health providers.

Responsibilities

Conduct feasibility and revenue analysis, including assessing Medi-Cal eligibility, mapping services to billable codes and rates, and producing a revenue model.
Identify which services are billable under standard Medi-Cal codes, which require special structuring, and which are not billable, advising on how to handle non-billable services.
Assess financial, administrative, and logistical considerations of billing through a third-party versus directly to Medi-Cal, and advise on a billing pathway.
If a third-party billing partner is chosen, assess potential partners in San Francisco (FQHCs, county behavioral health department, established Medi-Cal certified providers).
Advise on EHR requirements from a Medi-Cal billing and compliance standpoint to inform RFP and vendor evaluation.
Review internal readiness audit findings and advise on critical gaps before billing begins.
Help Compass build the infrastructure determined in Year 1, including billing setup (contract negotiation for third-party or advising on direct provider certification).
Advise on billing operations support, including denial pattern analysis, documentation improvement, and workflow optimization.
Support the development of billing compliance policies, utilization review processes, audit readiness procedures, and privacy protocols.
Help complete certification requirements, refine internal systems, and develop staff training.
Provide support in preparing and submitting the certification application if relevant.
Advise on integrating the internal Salesforce database (CoDa) with a new EHR.
Assist in preparing and administering staff training.