Revenue Cycle Manager

POSITION SUMMARY

Owns the whole revenue cycle for the FSP-HFW program, from client eligibility through claim payment, County invoicing, and Reconciliation and Final Settlement. This is the position SCCS names under Exhibit A §J as responsible for managing program funds.

Essential Duties and Responsibilities

• Lead Medi-Cal FFS billing for the program: claim submission, denial management, resubmission, and follow-up on unpaid claims.
• Make sure the monthly County invoice is submitted by the 20th on the County-approved form. Only dates of service on or after October 16, 2026 can be billed.
• Prepare or approve the monthly Expenditure & Revenue (E&R) report, due within 25 calendar days of month-end.
• Oversee Coordination of Benefits so 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 can't be billed to Medi-Cal.
• Track spending against the contract budget and the 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 Exhibit A requires.
• Keep the inventory of County IRIS tokens: who has each one by serial number, issuing and returning them, and reporting losses.
• Work with IT/EHR staff on billing setup in myEvolv, SCCS's EHR, EDI and claim files, and data exchanges with the State and County.
• Report billing KPIs every month (clean-claim rate, denial rate, days in A/R, 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.