Supervisor Business Services – Managed Care

Job Title: Supervisor Business Services – Managed Care
Job Location: Costa Mesa, CA
Job Duration: 2-3 Months (Direct Hire)
Payrate: $34.92 - $54.00/ hr. on w2 (Flexible)

Job 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.
• Client 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 Product 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.

Work Schedule:

• Work schedule is flexible between 6 and 8 AM start times; most staff being overseen is there from 6:00 AM–2:30 PM.