Manager, Hospital Billing Operations Billing and Collection @ MV

Manager, Hospital Billing Operations - FT - Days - Billing and Collection @ MV page is loaded## Manager, Hospital Billing Operations - FT - Days - Billing and Collection @ MVlocations:
Mountain View, CAtime type:
Full time posted on:
Posted Yesterday job requisition :
R
** El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward.  We are proud of our reputation in the community:
One built on compassion, innovation, collaboration and delivering high-quality care.  Come join the team that makes this happen.
**** Applicants MUST apply for position(s) by submitting a separate application for each individual job posting number they are interested in being considered for.
**** FTE
* * 1
* * Scheduled Bi-Weekly Hours
** 80
* * Work Shift
** Day: 8 hours
** Job Description
** 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.
** Knowledge, skills and abilities and

Key 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.
*
* Qualifications:

*** Bachelor’s degree in finance, accounting, healthcare administration, or related…