Medi-Cal Billing Manager

Please note: a cover letter is required for this position. Please tell us about your interest in working for KIPP!

Position Summary

The Medi-Cal Billing Manager will be primarily responsible for developing and managing the billing processes for the Children and Youth Behavioral Health Initiative (CYBHI) fee schedule program, while also ensuring clear data quality distinctions and systems that support both the CYBHI program and the Local Educational Agency Medi-Cal Billing Option Program (LEA BOP). This position will ensure accurate and timely claims submission, maintain compliance with state and federal regulations, and serve as a liaison between the organization and the Third-Party Administrator (TPA).

This is a hybrid role with the expectation that 2-3 days per week be spent onsite at our school campuses or at our Regional Support Office in Oakland.

Preferred Qualifications

Experience and Knowledge

• A minimum of 2 years of experience in healthcare billing, with a strong preference for experience in school-based health services or behavioral health billing.

• Familiarity with the Children and Youth Behavioral Health Initiative (CYBHI) fee schedule program or a willingness to quickly learn and adapt to new billing requirements.

• Demonstrated knowledge of Medi-Cal billing processes, including the Local Educational Agency Medi-Cal Billing Option Program (LEA BOP) and the School-Based Medi-Cal Administrative Activities (SMAA) program.

• Proficiency in using electronic health record systems and billing software, with the ability to learn new systems as needed.

• Understanding of medical coding, including Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes.

• Excellent organizational and time management skills, with the ability to prioritize tasks and meet deadlines in a fast-paced environment.

• Strong attention to detail and accuracy, with the ability to identify and resolve discrepancies in billing data.

• Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal staff, external vendors, and program administrators.

• Knowledge of Health Insurance Portability and Accountability Act (HIPAA) regulations, Family Educational Rights and Privacy Act (FERPA) and other relevant state and federal laws governing the privacy and security of protected health information.

Education:

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, Accounting, or a related field. Alternatively, an Associate's degree combined with relevant work experience may be considered.

Essential Functions and Responsibilities

• Develop and oversee the system of collection and maintenance of student insurance information, including private insurance, Medi-Cal, and other government-sponsored health programs.

• Collaborate with the TPA to establish and implement billing protocols for the CYBHI Fee Schedule Program, ensuring adherence to all program requirements and guidelines.

• Develop and maintain systems that support clear data quality distinctions between the CYBHI Fee Schedule Program and the Local Education Agency Billing Option Program

• Review and scrub claims prior to submission, verifying the proper use of National Provider Identifiers (NPIs) and confirming that provider licenses and credentials meet the necessary standards for the CYBHI Fee Schedule Program.

• Submit claims to the TPA for the CYBHI Fee Schedule Program and ensure accurate and timely processing.

• Reconcile payments received from the TPA, identifying and resolving any discrepancies or denied claims.

• Manage claims denials by investigating reasons for denials, correcting and resubmitting claims, and implementing process improvements to minimize future denials.

• Generate and analyze billing reports to monitor the organization's financial performance, identify trends, and make recommendations for process improvements.

• Stay current with state and federal regulations related to the CYBHI Fee Schedule Program, and the Local Education Agency Billing Option Program, ensuring the organization's billing practices remain compliant.

• Collaborate with the accounting and finance teams to support auditing processes, providing necessary documentation and clarification to ensure compliance with billing and revenue recognition standards.

• Provide training and support to staff members involved in the billing process, promoting best practices and fostering a culture of compliance

• Work with the TPA to organize training for school-based providers - to provide orientation to the required documentation.

• Serve as the primary point of contact for the TPA, maintaining open communication and collaborating to resolve any issues that arise.

• Coordinate with the LEA BOP billing vendor to ensure smooth integration and data quality between the two programs.

Physical, Mental and Environmental Demands

Physical: Ability to navigate office and school campuses, and hold meetings in different spaces. Traditionally, much of the day involves sitting. Ability to access and utilize technology. Physical agility to move self in various positions in order to execute duties effectively, which may include kneeling, walking, pushing/pulling, squatting, twisting, turning, bending, stooping and reaching overhead

Mental: Stress of deadlines and normal work standards, ability to analyze problems and generate alternatives, work with interruptions, concentrate for long periods of time, read, calculate, perform routine math problems, memorize and recall objects and people.

Environmental: Office environment subject to constant interruptions and distractions. KIPP adheres to health and safety guidelines as outlined by the CDC, CDE, and public health agencies' recommendations.

Classification

This is a full-time, exempt position based on a full year calendar based out of our Regional Support Office with possible travel to schools and districts. The KIPP Regional Support Office is currently operating in a hybrid fashion. Most positions can expect to work in person 2-3 days per week and remotely the remaining days, subject to change based on the needs of the role.

About KIPP Public Schools Northern California

We are a thriving nonprofit network of 22 free, public charter schools open to all students. At KIPP, we believe all children should grow up free to create the future they want for themselves and that schools can and should be a critical factor in making that vision a reality. Together with families and communities, we create joyful, academically excellent schools that prepare students with the skills and confidence to pursue the paths they choose-college, career, and beyond-so they can lead fulfilling lives and build a more just world.

Our student community consists of over 7,000 elementary, middle, and high school students in East Palo Alto, Oakland, San Francisco, San Lorenzo, San Jose, Redwood City, and Stockton. 79% qualify for free or reduced price lunch, 23% are multilingual learners, and 10% have special needs. We strive to cultivate a representative team of teachers and leaders that reflect our students' diversity.

Compensation

KIPP Northern California is dedicated to you and your family's well-being! We offer a competitive salary as well as a comprehensive benefits package including medical, dental, vision, and transportation benefits.

We benchmark annually against comparably-sized non-profit organizations in the regions where we operate, to offer competitive salaries. The salary range for this position is between $82,000 and $100,000. Most candidates would be compensated at $87,000.

How to Apply

Please submit a cover letter and resume by clicking apply on this page.

Please note: a cover letter is required for this position. Please tell us about your interest in working for KIPP!