Behavioral interventionist • carlsbad ca
Pacific Health Group (PHG) is a California-based integrated care organization delivering Enhanced Care Management (ECM), Community Supports (CS), and Behavioral Health (BH) services under the CalAI... Show more
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Support students in a dynamic school environment with flexible, per diem opportunities located in Oceanside, CA.This role is perfect for compassionate individuals committed to making a meaningful i... Show more
Support students in a dynamic school environment with flexible, per diem Instructional Aide opportunities in Oceanside, CA.These roles are perfect for compassionate professionals seeking to contrib... Show more
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Instructional Aide Substitute Opportunities – Per Diem | Oceanside, CA.Seeking compassionate professionals to provide vital support to students in a dynamic school environment.These per diem Instru... Show more
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Instructional Aide Subs Needed – Per Diem School-Based Opportunities in Carlsbad, CA.Seeking compassionate professionals to provide vital support to students in a structured school environment.Thes... Show more
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Instructional Aide Substitute – Per Diem | Oceanside, CA.A school-based opportunity is available for compassionate and dedicated Instructional Aides to provide 1:1 support to students.These per die... Show more
The average salary range is between $ 39,000 and $ 56,961 year , with the average salary hovering around $ 42,900 year .
ABOUT PACIFIC HEALTH GROUP
Pacific Health Group (PHG) is a California-based integrated care organization delivering Enhanced Care Management (ECM), Community Supports (CS), and Behavioral Health (BH) services under the CalAIM framework. We serve Medi-Cal members across multiple counties through contracts with managed care plans and county behavioral health systems. Our mission is simple: deliver whole-person care that meets people where they are—and make sure the systems behind that care run as effectively as the care itself.
THE ROLE
We’re looking for a detail-driven Billing Auditor who will own the critical space between service delivery and revenue collection. You’ll make sure that every claim we submit gets paid—correctly and completely. You’ll audit our claims, dig into EOBs and remittance advices, chase down underpayments, and build the systems that keep revenue from slipping through the cracks. This is not a passive paper-pushing role. You’ll be the person who catches what others miss and turns findings into action.
Pay - $25.00-$27.00
WHAT YOU’LL DO
▸ Reconcile every submitted claim against EOBs, 835 remittance advices, and payment records to verify we received full and accurate reimbursement.
▸ Audit PEPM payments against enrollment rosters, service logs, and LOA rate schedules across all MCP contracts.
▸ Identify underpayments, denials, zero-pays, and systematic payment discrepancies—then drive resolution.
▸ Prepare and file appeals for denied or underpaid claims with complete supporting documentation.
▸ Cross-reference clinical documentation, care plans, and EHR records against claims to find unbilled and under-billed services.
▸ Verify correct coding across HCPCS, CPT, and ICD-10—including CalAIM-specific ECM codes (G9007, G9008, G9012), CS codes and BH/SMHS codes.
▸ Build and maintain audit dashboards tracking denial rates, days in A/R, collection rates, and payer-level variances.
▸ Produce monthly revenue reconciliation reports for leadership with actionable findings.
▸ Recommend and implement process improvements that prevent revenue leakage at the source.
Requirements
▸ 3+ years in medical billing, claims auditing, or revenue cycle management in healthcare.
▸ Hands-on experience auditing EOBs, reconciling payments, and managing denials and appeals.
▸ Working knowledge of HCPCS, CPT, and ICD-10 coding.
▸ Proficiency with EHR/billing systems and strong Excel or Sheets skills for data analysis.
▸ Sharp analytical instincts and relentless attention to detail.
▸ Bachelor’s degree in healthcare administration, HIM, business, accounting, or equivalent experience.
BONUS POINTS
▸ Experience with Medi-Cal managed care, CalAIM (ECM/CS), or behavioral health billing.
▸ Familiarity with PEPM/capitated payment models.
▸ CPC, CCS, or equivalent coding certification.
▸ Knowledge of 837/835 electronic transaction standards.
▸ Background in community health, FQHCs, or integrated care settings.
Benefits
Benefits:
