SENIOR BILLING MANAGER (0923 - Manager II)

Company Description

The Department of Public Health prioritizes equitable and inclusive access to quality healthcare for its community and values the importance of diversity in its workforce. All employees at the Department of Public Health work to advance equity, inclusion, and diversity with a specific lens and focus on race, ethnicity, gender, sex, sexuality, disability, and immigration status. 

• Application Opening: December 20, 2024
• Application Deadline: Application filing will close on or after January 3, 2025
• Salary: 0923 Manager II (Effective January 4, 2025, Range A Salary between $141,700 and $180,856)
• Appointment Type: Permanent Civil Service
• Recruitment ID: PBT-0923-153351

The Mission of the San Francisco Department of Public Health (SFDPH) is to protect and promote the health of all San Franciscans. SFDPH strives to achieve its mission through the work of multiple divisions - the San Francisco Health Network, Population Health, Behavioral Health Services, and Administration. The San Francisco Health Network is the City’s only complete system of care and has locations throughout the City, including Zuckerberg San Francisco General Hospital and Trauma Center, Laguna Honda Hospital and Rehabilitation Center, and over 15 primary care health centers. The Population Health Division (PHD) provides core public health services for the City and County of San Francisco: health protection, health promotion, disease and injury prevention, and disaster preparedness and response. Behavioral Health Services operates in conjunction with SFHN and provides a range of mental health and substance use treatment services.

Job Description

Under direction of the Deputy Director, Patient Financial Services & Patient Accounting, the 0923 Senior Billing Manager is responsible for the successful billing in revenue generated from the San Francisco Health Network, Population Health, and Behavioral Health Services for the department to realize $752 million in reimbursement annually. This position provides leadership for the billing teams across the department and analyzes billing regulations and provider updates related to Medicare, Medi-Cal, and other private, government, and other city and county programs.

This position is also responsible for billing system updates and reports. This includes monthly revenue analysis by division, quarterly CMS credit balance reports for both hospitals, yearly Federally Qualified Health Center (FQHC) reconciliation. This position is also the Server Patching Owner for Experian network upgrades and tests, requiring 24/7 availability during EPIC system patching windows.

The Senior Billing Manager also performs the following essential duties: 

1. Manages patient accounting staff, including patient accounts managers, supervisors, and billing staff
2. Resolves all EPIC billing claim edits across all hospitals and divisions
3. Monitors, interprets, and implements billing regulations and provider updates related to Medicare, Medi-Cal and other Private, Government, Other City and County programs
4. Prepares monthly revenue analysis by division, related to claims submission volume and trends based on claim/error type and/or payer, including outstanding unbilled revenue.
5. Develops, interprets, coordinates, and enforces policies and procedures specific to each division's revenue
6. Prepares quarterly CMS credit balance reports for all DPH Zuckerberg San Francisco General (ZSFG) and Laguna Honda Hospital & Rehabilitation Centerl (LHH) Medicare Provider Transaction Access Numbers (PTANS), attesting to accuracy in submission of certification and ensuring credit balance corrections are completed in accordance with CMS 835 instructions
7. Prepares, submits and certifies yearly Federally Qualified Health Center (FQHC) reconciliation for 19 DPH/CCSF FQHC clinics, including ensuring all valid visits and differential rate claims are properly billed and reimbursed by all payors and all undistributed payments are properly aligned with valid visits within the timeline for reporting to California Department of Health Care Services (DHCS)
8. Oversees all billing, follow-up and collections within LHH to successful adjudication of all gross revenue in accordance with Skilled Nursing Facility/Long Term Care (SNF/LTC) and Laguna Honda Hospital specific guidelines
9. Creates Hospital Account Records (HARs) for all organ donor accounts involving Donor Network West, including interpreting medical chart to determine Donor Network responsibility and splitting gross revenue between Donor Network West and private insurance, and ensuring coding accuracy to