SENIOR BILLING MANAGER (0923 - Manager II) - City and County of San Francisco

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.

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 avoid inappropriate billing
10. Acts as the Server Patching Owner for Experian network upgrades and tests, available 24/7 during patching windows

The Senior Billing Manager (0923 Manager II) may perform other duties as assigned or required.

Required Minimum Qualifications (all applicants must verify that they meet both elements below):

Education: Possession of a bachelor's degree from an accredited college or university; AND

Experience: Four (4) years of experience in billing, claims processing, and/or collecting healthcare service reimbursements

Education Substitution: Additional qualifying experience may substitute for the degree requirement on a year-for-year basis. One year (2,000 hours) of qualifying experience will be considered equivalent to 30 semester units/45 quarter units.

Note: One-year full-time employment is equivalent to 2,000 hours (2,000 hours of qualifying work experience is based on a 40-hour work week).

Applicants must meet the minimum qualification requirement by the final filing date unless otherwise noted.

DESIRABLE QUALIFICATIONS: The stated desirable qualifications may be considered at the end of the selection process when candidates are referred for hiring:

• Two years of experience supervising staff performing billing, claims processing, or healthcare service reimbursements
• EPIC Resolute Hospital Billing Certificate and/or EPIC Resolute Professional Billing Certificate

Important Note: Please make sure it is absolutely clear in your application exactly how you meet the minimum qualifications. Applicants may be required to submit verification of qualifying education and experience at any point during the recruitment and selection process. Please be aware that any misrepresentation of this information may disqualify you from this recruitment or future job opportunities.

Selection Procedures:

After application submission, candidates deemed qualified must complete all subsequent steps to advance in this selection process, which includes the following.

Supplemental Questionnaire (SQ) (Weight: 100%): Candidates who qualify will be invited to participate in a Supplemental Questionnaire (SQ) that is designed to measure the knowledge, skills, and abilities in job-related areas which may include but not be limited to: Knowledge of elements and individual payor requirements for medical billing such as UB-04, CMS-1500, 837I, 837P, and 277, knowledge of CMS FQHC reporting requirements, knowledge of donor organ billing, coding, and coordination processes, and knowledge of SNF/LTC billing and follow-up requirements.

The SQ will be emailed to the address listed on the candidate’s online application. Candidates will be required to respond to the SQ in the time frame indicated and must submit the completed questionnaire as directed in order to have it evaluated. Responses cannot be changed once submitted. Candidates will be evaluated based on their SQ responses.

Candidates must achieve a passing score in order to continue in the selection process. Candidates will be placed on the confidential eligible list/score report in rank order according to their final score.

Additional selection processes may be conducted by the hiring department prior to making final hiring decisions.

Certification
The certification rule for the eligible list resulting from this examination will be the Rule of the List.

Eligible List/Score Report:
Once you pass the exam, you will be placed onto an eligible list and given a score and a rank. For more information, visit https://careers.sf.gov/knowledge/process/

The duration of the eligible list resulting from this examination process will be 6 months and may be extended with the approval of the Human Resources Director.

How to apply:

Applications for City and County of San Francisco jobs are only accepted through an online process. Visit careers.sf.gov and begin the application process. 

Our e-mail communications may come from more than one department so please make sure your email is set to accept messages from all of us at this link. 

Applicants may be contacted by email about this recruitment therefore, it is their responsibility to contact the Analyst if they update their email address. 

Applicants will receive a confirmation email that their online application has been received in response to every announcement for which they file. Applicants should retain this confirmation email for their records. Failure to receive this email means that the online application was not submitted or received.

Terms of Announcement and Appeal Rights:

This is a Position Based Test (PBT) administered in accordance with Civil Service Rule 111A.

Applicants must be guided solely by the provisions of this announcement, including requirements, time periods and other particulars, except when superseded by federal, state or local laws, rules or regulations. Clerical errors may be corrected by the posting the correction on the Department of Human Resources website at https://careers.sf.gov/. The terms of this announcement may be appealed under Civil Service Rule 111A.35.1. The standard for the review of such appeals is ‘abuse of discretion’ or ‘no rational basis’ for establishing the position description, the minimum qualifications and/or the certification rule. Appeals must include a written statement of the item(s) being contested and the specific reason(s) why the cited item(s) constitute(s) abuse of discretion by the Human Resources Director. Appeals must be submitted directly to the Executive Officer of the Civil Service Commission within five business days of the announcement issuance date. 

Additional information regarding Employment with the City and County of San Francisco: 

• Information about the Hiring Process 

• Conviction History 

• Employee Benefits Overview 

• Equal Employment Opportunity 

• Disaster Service Workers

• Reasonable Accommodation

• Right to Work

• Copies of Application Documents

• Diversity Statement

• Veterans Preference

• Seniority Credit in Promotional Exams

If you have any questions regarding this recruitment or application process, please contact the analyst, Steven Scoles at steven.scoles@sfdph.org or (628) 271-6828. 

We may use text messaging to communicate with you on the phone number provided in your application. The first message will ask you to opt in to text messaging.

The City and County of San Francisco encourages women, minorities and persons with disabilities to apply. Applicants will be considered regardless of their sex, race, age, religion, color, national origin, ancestry, physical disability, mental disability, medical condition (associated with cancer, a history of cancer, or genetic characteristics), HIV/AIDS status, genetic information, marital status, sexual orientation, gender, gender identity, gender expression, military and veteran status, or other protected category under the law.