Supv. Business Services – Managed Care

Job Description Summary:

The Business Services Supervisor provides leadership and operational oversight for the Government Billing team responsible for hospital billing and collections for Medicare and Medi-Cal. Hoag is prioritizing deep hands-on experience in Traditional Medicare hospital billing for this role. The Supervisor is accountable for daily production control claim quality denial prevention timely follow-up and staff development while serving as the escalation point for complex payer claim and patient issues.
This role requires true Medicare institutional subject matter expertise across the end-to-end claim lifecycle (submission to final resolution) including rejected and RTP claims remittance analysis underpayment identification appeals strategy and cross-functional barrier removal with Coding HIM Patient Access Revenue Integrity Case Management/UR (as needed) and IT.

Role Scope and Key Outcomes
-Stabilize and sustain clean Medicare institutional claim production reducing RTP volume rework and preventable denials.
-Improve Medicare cash acceleration through disciplined follow-up appeal timeliness and underpayment recovery.
-Ensure audit-ready documentation decisioning and compliance with CMS and Medi-Cal requirements.
-Build a high-performing team through coaching training accountability and effective workload management.
-Partner cross-functionally to eliminate systemic Epic build or workflow defects that create recurring claim failures.

Job Responsibilities:
--Medicare Hospital Billing Operations (Primary Accountability):
-Direct day-to-day operations for Traditional Medicare institutional billing and follow-up across inpatient and outpatient service lines.
-Own the end-to-end institutional claim lifecycle including 837I submission 277CA rejections RTP correction 835 remittance review credit balance or recoupment workflows and appeal preparation and tracking.
-Serve as the primary escalation point for complex Medicare billing scenarios and guide staff to correct compliant resolution paths.
-Implement production controls that prioritize high-dollar and high-risk Medicare accounts while maintaining throughput and quality.
--Medicare Technical Competencies Expected in This Role:
-Type of Bill (TOB) and institutional claim structures including when and how to use inpatient vs outpatient claim types (for example 11x 12x 13x; 14x and 18x where applicable).
-Part B inpatient billing workflows when applicable including the operational dependency on a finalized inpatient claim history when required for downstream processing.
-Medicare timely filing controls and exception pathways including span-date considerations for institutional claims and prevention of repeat untimely submissions.
-Three-Day (or One-Day) Payment Window identification and operational integration including correct inclusion of prior outpatient diagnostic services and admission-related services as required.
-Eligibility and entitlement troubleshooting (Part A vs Part B) MBI validation and date-of-death or eligibility discrepancy resolution through appropriate internal and external channels.
-MSP identification and coordination of benefits workflows including correct payer sequencing documentation and escalation.

Required Skills & Experience:
-Three (3) years of experience in hospital Revenue Cycle.
-Three (3) years of experience in hospital AR management and Medicare and medi-Cal PPO/HMO claim adjudications for Government Billing and Collecting Department.
-Experience in all phases of billing and working knowledge of federal and state regulations and requirements related to government billing.
-Oral/Written Communication.
-Ability to speak and write effectively demonstrates fundamental command of language communicates well using all mediums.

Preferred Skills & Experience:
-Two (2) years of supervisory experience.

Required Education:
-High school diploma or equivalent.