Government Program - Billing Supervisor

Washington Hospital•Fremont, CA

18d•$92,000 - $133,000

About The Position

The Hospital Government Billing Supervisor is responsible for directing the day-to-day operations of the government payer billing function within the hospital's Revenue Cycle department. This position ensures the accurate, compliant, and timely submission of claims to Medicare, Medicaid, TRICARE, VA, and other federal and state-funded programs. The Supervisor leads a team of billing professionals, drives measurable performance outcomes, and serves as the organization's primary subject matter expert on government payer regulations, reimbursement methodologies, and compliance requirements. This role requires exceptional organizational skills, a commitment to professional excellence, and a proactive approach to continuous process improvement.

Requirements

Bachelor's degree in Healthcare Administration, Business, Finance, or a related field; equivalent experience considered.
Minimum 5 years of hospital billing experience with at least 2 years in a supervisory or lead role.
Comprehensive knowledge of Medicare and Medicaid billing regulations, including UB-04 and CMS-1500 claim form requirements.
Proficiency with healthcare billing systems (Epic, Meditech, Gerner, or equivalent) and Microsoft Office Suite.
Strong working knowledge of ICD-10-CM, CPT, and HCPCS Level II coding systems.
Demonstrated experience in denial management, appeals coordination, and accounts receivable resolution.

Nice To Haves

Certified Professional Biller (CPB), Certified Revenue Cycle Professional (CRCP), or Certified Healthcare Financial Professional (CHFP).
Experience navigating RAC, MAC, UPIC, and OIG audit processes.
Familiarity with value-based care models, bundled payments, and 3408 drug program billing.

Responsibilities

Establish and monitor key performance indicators (KPls) including AR days, denial rates, first-pass resolution rates, cash collections, and claim submission timeliness.
Set clear, measurable goals for direct reports and hold team members accountable for achieving individual and departmental benchmarks.
Analyze billing data and trending reports to identify opportunities for revenue recovery and process efficiency.
Consistently meet or exceed payer-specific timely filing requirements and department collection goals.
Lead denial management efforts to reduce denial rates and increase net collections across all government payers.
Report results to leadership with transparency, actionable recommendations, and data-driven insights.
Implement corrective action plans when performance metrics fall below established targets.
Apply advanced knowledge of Medicare fee-for-service, Medicare Advantage, Medicaid FFS, and managed Medicaid billing rules.
Interpret Remittance Advice Remark Codes (RARCs), Claim Adjustment Reason Codes (CARCs), and payer-specific denial rationale.
Proficiently navigate clearinghouse platforms, government payer portals (FISS, MCS, MMIS), and billing system worklists.
Demonstrate competency in constructing and submitting appeals at all levels, including Redeterminations, Reconsiderations, ALJ hearings, and MAC appeals.
Utilize reporting tools and business intelligence platforms to extract and interpret revenue cycle data.
Train and coach staff on claim form completion, modifier usage, revenue code assignment, and payer policy interpretation.
Effectively present complex billing issues and solutions to cross- functional leadership teams.