Medi-Cal Billing Infrastructure Consultant

Medi‑Cal Billing Infrastructure Consultant – Compass Family Services Compass Family Services is a nonprofit organization dedicated to assisting San Francisco families who are homeless or at‑risk of homelessness to achieve housing stability, economic self‑sufficiency, and overall well‑being. One of our thirteen direct‑service programs, Compass Behavioral Health Services (CBHS), provides a range of behavioral health services, including short‑ and long‑term therapy, individual, couples and family therapy, clinical consulting to frontline staff, therapeutic shadowing, counselor‑of‑the‑day support, children’s play therapy, and support groups. In Fall 2025, Compass received a four‑year Hellman Foundation grant to build Medi‑Cal billing infrastructure for CBHS. Compass is seeking an experienced consultant to guide this infrastructure building process. Scope of Work Full project timeline spans three years. Compass will contract with a selected consultant for an initial Year1 term. Ongoing partnership beyond Year1 is contingent upon performance and project progress. Year1 (August2026 – June2027) – $30,000 The consultant’s primary contribution in Year1 is to conduct a series of analyses and produce key deliverables that will directly inform three foundational decisions: which services to bill, whether to bill Medi‑Cal directly or through a third‑party, and which Electronic Health Record system (EHR) to select. Feasibility and revenue analysis: assess the Medi‑Cal eligibility rate among current CBHS clients, map CBHS services to billable Medi‑Cal benefit categories, CPT/HCPCS codes, license types, and applicable rates, and produce a revenue model with low, mid, and high scenarios that validates or revises the internal projection of $200,000+ in first‑year billing revenue. Billability analysis: identify which CBHS services are billable under standard outpatient Medi‑Cal codes, which require special structuring, and which are not billable; advise on how non‑billable services should be handled in the billing model. Billing process determination: assess financial, administrative, and logistical considerations for billing through a third‑party versus billing Medi‑Cal directly; advise on the optimal billing pathway and evaluate potential partners in San Francisco. EHR advisory: advise on EHR requirements from a Medi‑Cal billing and compliance standpoint to inform the internal RFP and vendor evaluation process. Internal readiness input: review internal readiness audit findings (clinical documentation practices, supervision structure, license mix) and advise on critical gaps to address before billing begins. Year2 (July2027 – June2028) – $100,000 The consultant’s primary contribution in Year2 is to help Compass build the infrastructure determined in Year1. Billing setup: if a third‑party billing partner is chosen, participate in contract negotiation and advise on administrative fee structures, data access rights, clinical autonomy, off‑ramp terms, and IP ownership. Direct billing: if Medi‑Cal direct billing is chosen, advise on the specific certification pathway and setup requirements. Billing operations support: advise on denial pattern analysis, documentation improvement, and workflow optimization during billing operations. Compliance infrastructure: support development of billing compliance policies, utilization review processes, audit readiness procedures, and privacy protocols to Medi‑Cal standards. Year3 (July2028 – June2029) – $50,000 The consultant’s primary contribution in Year3 is to help Compass complete certification requirements, refine internal systems, and develop training for staff. Certification application support: provide direct support in preparing and submitting the certification application, including required documentation, readiness evidence, and responses to review or site visit requirements. Internal systems: advise on integration of the internal Salesforce database (CoDa) for client clinical case notes with the new EHR. Training: assist in preparing and administering staff training. Organizational Context CBHS is low‑barrier and clients do not need a clinical diagnosis to receive services; a billing model will require a diagnostic pathway for clients entering the billable track. CBHS therapists currently hold a mix of licenses (LCSW, LMFT, ASW, AMFT, clinical interns); consultant must advise on how this mix may affect billing capacity. CBHS currently receives City of San Francisco contract funding for services that may not be Medi‑Cal billable; consultant must be comfortable working with a model where Medi‑Cal and government funding coexist. This role requires deep knowledge of the California Medi‑Cal behavioral health system, experience with community‑based nonprofit providers, and the ability to work collaboratively with Compass staff who are new to Medi‑Cal. #J-18808-Ljbffr Compass Community Services