Medi-Cal Billing Infrastructure Consultant

Compass Family Services•San Francisco, CA

12d•$30,000

About The Position

Compass Family Services, a nonprofit organization dedicated to assisting San Francisco families facing homelessness 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 of CBHS. The ideal partner will have deep knowledge of the California Medi-Cal behavioral health system, experience with community-based nonprofits, and the ability to collaborate effectively with an internal team new to Medi-Cal billing. This is an initial one-year contract with the potential for an additional two years of partnership, contingent on performance and project progress. The full project timeline spans three years, with Year 1 focusing on analyses and key deliverables to inform foundational decisions about which services to bill, the billing pathway (direct vs. third-party), and EHR system selection. Years 2 and 3 will focus on implementation, setup, compliance, and training.

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.
Experience with California Medi-Cal Behavioral health billing.
Experience with nonprofit community-based providers.
Experience with the San Francisco county landscape.
Resume.
Narrative description of relevant content experience.
Narrative description of relevant consulting or partnership experience, including a brief description of past project(s) and your role, what your work entailed, and what the client achieved.
Proposal for Year 1 scope of work, including how you would structure the work, what you would need from Compass to be effective, your availability and capacity, and your proposed fee structure for Year 1.

Nice To Haves

Understanding of the clinical and mission implications of establishing a diagnostic pathway for clients entering a 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.

Responsibilities

Conduct feasibility and revenue analysis, including assessing Medi-Cal eligibility rates, mapping services to billable categories, CPT/HCPCS codes, license types, and applicable rates, and producing a revenue model.
Perform billability analysis to identify billable, conditionally billable, and non-billable services, and advise on handling non-billable services.
Assess financial, administrative, and logistical considerations for direct Medi-Cal billing versus third-party billing and advise on the optimal billing pathway.
If a third-party billing partner is chosen, assess potential partners in San Francisco, including FQHCs, the county behavioral health department, and established Medi-Cal certified providers.
Advise on EHR requirements from a Medi-Cal billing and compliance standpoint to inform the RFP and vendor evaluation process.
Review internal readiness audit findings and advise on critical gaps to address before billing begins.
Assist with billing setup, including contract negotiation with third-party billing partners or advising on direct Medi-Cal provider certification.
Provide billing operations support, including advising on denial pattern analysis, documentation improvement, and workflow optimization.
Support the development of billing compliance policies, utilization review processes, audit readiness procedures, and privacy protocols.
Provide support in preparing and submitting certification applications if relevant.
Advise on integrating the internal Salesforce database (CoDa) with a new EHR system.
Assist in preparing and administering staff training.