Manager, Hospital Billing Operations - FT - Days - Billing and Collection @ MV

El Camino Health•Mountain View, CA

3d•$68 - $101

About The Position

The Manager, Hospital Billing Operations is responsible for overseeing the daily operations of the hospital billing team within the Patient Accounts Department, ensuring accurate and compliant billing practices for all payers, including Medicare, Medi-Cal, and commercial insurance plans (e.g., HMO and PPO). This role requires extensive knowledge of Medicare regulations, compliance standards, and expertise in Correct Coding Initiative (CCI) edits and Medically Unlikely Edits (MUEs). The Manager, Hospital Billing Operations will lead a team, implement process improvements, and serve as a subject matter expert on payer requirements and regulatory changes.

Requirements

Bachelor’s degree in finance, accounting, healthcare administration, or related field preferred.
Minimum seven (7) years of progressive experience in Medicare, commercial, and Medi-Cal billing in a hospital setting.
At least three (3) years of management or supervisory experience, preferably overseeing multiple teams or functions within a hospital revenue cycle environment.
Extensive knowledge of Medicare and Medi-Cal billing regulations and compliance standards
In-depth understanding of CCI edits and MUEs
Familiarity with commercial payer billing requirements
Proven ability to lead, mentor, and develop coordinators (team leads) and staff.
Strong analytical skills with the ability to interpret data, monitor key performance indicators, and drive operational improvements.
Ability to interact effectively with all levels of employees, physicians, and cross-functional teams throughout the organization.
Excellent organizational skills: able to manage multiple priorities and meet deadlines in a fast-paced environment.
Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint).
Excellent verbal and written communication skills.
Ability to foster teamwork, build collaborative relationships, and promote a positive work environment.
Strong attention to detail and ability to multitask.
Strong analytical and critical thinking skills with proven problem-solving ability.
Customer service oriented, with adaptability to changing priorities.
Ability to learn quickly and adapt to multiple workflows and systems.
Exceptional communication and training skills.

Nice To Haves

Experience with Epic or other hospital billing/revenue cycle management systems is strongly preferred.

Responsibilities

Ensure all billing practices are fully compliant with current Medicare regulations, CMS guidelines, and payer-specific requirements.
Remain current on changes to Medicare, Medi-Cal, and commercial insurance regulations and policies, and effectively communicate relevant updates to the billing and follow-up staff.
Oversee the accurate and timely submission of claims to Medicare, Medi-Cal, and commercial payers.
Monitor claim status, follow up on outstanding claims, and ensure prompt resolution of issues.
Work closely with the ICare team (Information Technology Department) on billing edits and billing requirements.
Analyze Medicare denials and rejections, identify root causes, and implement corrective actions.
Develop and maintain effective processes for appeals and reconsiderations.
Ensure proper application of CPT, HCPCS, and ICD-10 codes in accordance with Medicare guidelines; collaborate with the Health Information Management Services (HIMS) Coding Manager and Revenue Integrity Department to resolve coding issues and ensure accurate claim submission.
Oversee the use of CCI edits and MUEs to ensure claims are compliant and minimize denials.
Provide ongoing training to billing and Medicare follow-up staff on Medicare regulations, compliance updates, and best practices.
Develop educational materials and tip sheets and conduct regular meetings with staff.
Conduct regular internal audits of Medicare, commercial, and Medi-Cal claims to ensure accuracy and compliance.
Address audit findings and implement process improvements as needed.
Develop and update billing policies and procedures to ensure compliance with Medicare, Medi-Cal, and commercial payer requirements.
Prepare and present reports on billing performance and compliance issues to Patient Accounts senior management.
Track key performance indicators (KPIs) related to Medicare, commercial, and Medi-Cal billing and follow-up.
Collaborate with Compliance, Health Information Management Coding, Revenue Integrity, and clinical teams to resolve complex billing issues and ensure accurate documentation.
Serve as the Patient Accounts Department’s primary point of contact for Medicare billing inquiries and audits.
Monitor and interpret changes in Medicare regulations and payer policies, ensuring timely implementation of necessary updates to billing processes; collaborate with the Revenue Integrity Department and Managed Care Contracting Department on payer regulations and policies.