Job Description – Supervisor, Business Services (Managed Care) Department: Business Services – Managed Care Job Title: Supervisor, Business Services – Managed Care Job Type: Direct Hire Schedule: Full-Time, 40 hours/week (Flexible start between 6:00 AM – 8:00 AM) Work Setting: Onsite Team Size: Approximately 12 direct reports Job Summary The Business Services Supervisor provides leadership and operational oversight for the Government Billing team responsible for hospital billing and collections related to Medicare and Medi-Cal accounts. This role requires strong hands-on expertise in Traditional Medicare institutional hospital billing across the full claim lifecycle—from claim submission through final resolution. The supervisor oversees production quality, denial prevention, collections performance, and staff development while acting as the escalation point for complex billing and payer issues. Key Responsibilities Medicare Hospital Billing Operations Supervise daily operations for Medicare institutional hospital billing and follow-up activities across inpatient and outpatient services. Manage the complete claim lifecycle including: RTP (Return to Provider) corrections Appeals preparation and tracking Underpayment and recoupment workflows Serve as escalation resource for complex Medicare billing issues. Implement productivity and quality controls to prioritize high-value accounts. Reduce claim rework, RTP volumes, and preventable denials. Ensure timely follow-up to accelerate Medicare cash collections. Operational Leadership Lead, coach, and develop billing staff. Monitor daily production and claim quality performance. Maintain compliance with CMS and Medi-Cal regulations. Ensure audit-ready documentation and billing practices. Collaborate cross-functionally with: Coding HIM Revenue Integrity IT teams Institutional billing structures and Type of Bill (TOB) usage (e.g., 11x, 12x, 13x, 14x, 18x). Medicare Part A and Part B billing workflows. Timely filing requirements and exception management. Three-Day/One-Day Payment Window processing. Eligibility and entitlement verification (Part A vs Part B). Medicare Beneficiary Identifier (MBI) validation. MSP (Medicare Secondary Payer) coordination and payer sequencing. Denial management and appeals strategy. Required Qualifications Minimum 3 years of hospital Revenue Cycle experience . Minimum 3 years of hospital AR management experience . Strong experience with: Medi-Cal PPO/HMO government billing adjudication Knowledge of federal and state government billing regulations. Experience in all phases of hospital billing (institutional billing required). Strong written and verbal communication skills. Preferred Qualifications 2+ years of supervisory or leadership experience. RHIA or RHIT certification preferred. Education Requirements Required: High school diploma or equivalent Preferred: RHIA or RHIT certification Additional Requirements Must have hospital billing experience (professional billing experience alone is not acceptable). Strong Medicare inpatient billing and CMS regulation knowledge required. Must stay current with Medicare billing regulations and updates. Position supervises approximately 12 employees. #J-18808-Ljbffr