Medicare Manager Jobs in Riverside, CA (NOW HIRING)

Position Overview

The Medicare Specialist Supervisor is responsible for overseeing the daily operations of the Medicare Intake and Documentation team within the Durable Medical Equipment (DME) organization. This role ensures compliance with Medicare regulations, Local Coverage Determinations (LCDs), supplier standards, and company policies while driving productivity, quality, and customer service excellence.

The Supervisor provides leadership, coaching, and performance management to Medicare Specialists and serves as a subject matter expert on Medicare documentation requirements, coverage criteria, prior authorization requirements, and audit readiness. This position works closely with Customer Care, Billing, Clinical Services, Sales, Compliance, and Revenue Cycle teams to ensure timely processing of Medicare orders and optimal reimbursement outcomes.

Essential Duties and Responsibilities

Team Leadership & Management

• Supervise, coach, and develop Medicare Specialists and related support staff to support operational performance and compliance objectives.
• Conduct regular one-on-one meetings, performance evaluations, and productivity reviews to drive accountability and employee development.
• Monitor staffing levels and distribute workloads to ensure timely and efficient order processing.
• Create and implement training plans and ongoing education focused on Medicare regulations, documentation requirements, and operational best practices.
• Foster a culture of accountability, compliance, and continuous improvement.

Medicare Operations

• Oversee the review and processing of Medicare orders to ensure accuracy, completeness, and timely progression through the intake workflow.
• Ensure all required documentation is obtained and validated prior to order fulfillment, including Standard Written Orders (SWOs), Face-to-Face documentation, chart notes, medical necessity documentation, and prior authorizations when applicable.
• Review and resolve complex Medicare eligibility, coverage, and documentation issues.
• Monitor order queues, aging reports, and workflow backlogs to ensure service level expectations are consistently met.
• Escalate and resolve high-risk, high-value, or time-sensitive orders as needed.

Compliance & Quality Assurance

• Maintain compliance with Medicare Supplier Standards, CMS regulations, Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), accreditation requirements, and company policies and procedures.
• Conduct quality audits of completed orders and team workflows to identify gaps and ensure audit readiness.
• Analyze trends related to denials, audits, and documentation deficiencies, and recommend corrective actions.
• Partner with Compliance and Revenue Cycle teams to implement corrective action plans and strengthen operational controls.
• Support Medicare audits, Additional Documentation Requests (ADRs), Targeted Probe and Educate (TPE) reviews, and other payer-related requests.

Process Improvement

• Analyze operational metrics and performance data to identify opportunities for improved efficiency, accuracy, and reimbursement outcomes.
• Develop, maintain, and refine standard operating procedures (SOPs) to support consistency and compliance.
• Collaborate with system administrators to optimize workflows within Brightree and related operational systems.
• Participate in process improvement initiatives and projects related to Medicare regulations, documentation workflows, and system enhancements.

Cross-Functional Collaboration

• Partner with Customer Care, Clinical Services, Billing, Revenue Cycle Management, Compliance, Sales, and Branch Operations to support efficient order processing and reimbursement success.
• Serve as the primary escalation point for physicians, referral sources, and internal stakeholders regarding Medicare documentation and coverage requirements.
• Communicate regulatory updates, workflow changes, and operational impacts to leadership and staff as needed.

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Key Performance Indicators (KPIs)

Performance in this role will be measured by the successful achievement of the following operational and compliance metrics:

• Order processing turnaround time
• Documentation completion and accuracy rates
• Medicare denial and rework rates
• First-pass claim acceptance rate
• Team productivity, queue management, and aging performance
• Audit findings, compliance scores, and documentation quality
• Employee engagement, retention, and overall team development

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Qualifications

Education

• High School Diploma or GED required.
• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or related field preferred.

Experience

• Minimum of five (5) years of experience in the Durable Medical Equipment (DME) industry required.
• Minimum of three (3) years of Medicare-focused operational experience required.
• Minimum of two (2) years of supervisory, team lead, or leadership experience preferred.
• Demonstrated expertise in Medicare coverage criteria, documentation standards, and reimbursement workflows.

Knowledge, Skills, and Abilities

• Advanced knowledge of Medicare Part B regulations, DMEPOS documentation requirements, prior authorization processes, and coverage criteria across respiratory, mobility, urological, enteral, and other DME product categories.
• Strong understanding of audit readiness, denial prevention strategies, and payer documentation requirements.
• Experience working within Brightree or similar DME management systems.
• Strong analytical, problem-solving, and decision-making capabilities.
• Effective leadership, coaching, and team development skills.
• Excellent verbal and written communication skills with the ability to communicate complex Medicare requirements clearly.
• Ability to manage multiple priorities and adapt in a fast-paced, high-volume environment.
• Proficiency in Microsoft Office Suite, operational reporting tools, and performance dashboards.

*** Travel to California Offices Required Quarterly ***