Revenue Cycle Manager

South Coast Children's Society•Placentia, CA

About The Position

The Revenue Cycle Manager owns the complete revenue cycle for the FSP-HFW program, from client eligibility through claim payment, County invoicing, reconciliation, and final settlement. SCCS identifies this role under Exhibit A §J as responsible for managing program funds. The role leads Medi-Cal fee-for-service billing, County invoicing, reporting, coordination of benefits, budget tracking, settlement, and audit support. It also coordinates billing systems and data exchanges, maintains County IRIS token inventory, reports billing performance, and keeps billing policies current with applicable state and County guidance.

Requirements

Bachelor's degree in accounting, finance, health administration, or a related field; equivalent experience may substitute.
At least 5 years of healthcare billing experience, including at least 3 years in California Medi-Cal Specialty Mental Health Services (SMHS) or behavioral health.
At least 2 years of experience 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.
Complete County BHS New User Training, Annual Provider Training, Annual Compliance Training, and HIPAA/42 CFR Part 2 training.
Ability to drive a motor vehicle without restrictions, often in heavy traffic and frequently over long distances.
Vision, hearing, and smell sufficient to regularly operate a motor vehicle, visualize environmental threats or risks to clients, and operate safely in the field.
Ability to occasionally lift and carry 10–20 pounds.
Ability to regularly sit, stand, climb stairs (one or more flights), and walk while traveling to and during family visits.
Ability to regularly sit and use a computer in office settings.

Nice To Haves

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

Responsibilities

Lead Medi-Cal fee-for-service billing, including claim submission, denial management, resubmission, and follow-up on unpaid claims.
Submit the monthly County invoice by the 20th using the County-approved form.
Ensure that only dates of service on or after October 16, 2026 are billed.
Prepare or approve the monthly Expenditure & Revenue report, due within 25 calendar days of month-end.
Oversee Coordination of Benefits to ensure 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 cannot be billed to Medi-Cal.
Track spending against the contract budget and 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 required by Exhibit A.
Maintain the inventory of County IRIS tokens, including recording holders by serial number, issuing and returning tokens, and reporting losses.
Work with IT/EHR staff on billing setup in myEvolv, EDI and claim files, and data exchanges with the State and County.
Report monthly billing KPIs, including clean-claim rate, denial rate, days in A/R, and 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.