Patient Accounting Manager; Claims Manager

*** RECRUITMENT EXTENDED***

Contra Costa Health is offering an excellent opportunity for two (2) Patient Accounting Managers within Contra Costa Health Plan (CCHP). CCHP is a federally qualified, state-licensed, and county-sponsored Health Maintenance Organization (HMO) serving Contra Costa County in the East Bay of the San Francisco Bay Area. Established in 1973, CCHP was the first county-sponsored HMO in the United States and today serves as the largest managed care health plan in Contra Costa County, covering more than 250,000 residents.

CCHP is committed to providing equitable, accessible, and high-quality healthcare to our culturally and linguistically diverse members. Within CCHP, the Patient Accounting Manager will serve as the manager of the CCHP Claims Department, overseeing claims operations to ensure accurate and timely processing, compliance with Medi-Cal, Medicare, and commercial payer requirements, and alignment with the plan’s mission of supporting member and provider needs.

Contra Costa Health Services (CCHS), the broader health system in which CCHP is housed, is the largest department in Contra Costa County with more than 4,000 employees, providing integrated healthcare services and serving as the safety net for low-income and uninsured residents.

• Experienced in Managed Care: Brings direct experience in health plan claims operations within a managed care environment
• Knowledgeable in Medicaid and Medicare: Understands Medi-Cal and Medicare program requirements, including billing, payment, and compliance
• A Strong Communicator: Able to clearly explain complex billing and claims issues to staff, providers, and leadership
• Solution-Oriented: Approaches challenges with a positive attitude and a commitment to continuous improvement
• Professional and Collaborative: Excels at working in a team environment while maintaining accountability
• Discreet and Judicious: Exercises good judgment in handling confidential and sensitive matters
• Supportive: Invests in the training, coaching, and professional development of staff

• Managing and supervising claims operations for CCHP, including claims processing, adjustments, and payment integrity
• Selecting, training, evaluating, and monitoring the performance of subordinate personnel, including supervisors and clerical staff
• Overseeing workflows to ensure timely and accurate adjudication of claims across Medi-Cal, Medicare, and commercial lines of business
• Serving as liaison with providers, county healthcare staff, and external stakeholders to resolve claims-related issues
• Ensuring compliance with federal, state, and local regulations as well as managed care, Medi-Cal, and Medicare standards
• Monitoring claims performance metrics, including timeliness, accuracy, and compliance with DHCS (Department of Health Care Services), DMHC (Department of Managed Health Care) requirements, and CMS (Center for Medicare and Medicaid Services)
• Reporting key claims issues, trends, and operational updates to higher management in a timely manner
• Collaborating with Finance, Utilization Management, Compliance, and other divisions to align claims operations with organizational goals

• You will have a direct role in ensuring providers are paid accurately and members’ claims are handled efficiently
• You will work in a dynamic environment with dedicated professionals focused on operational excellence and equity
• You will help support CCHP’s mission of providing high-quality healthcare to the county’s most vulnerable populations
• You will be part of a collaborative, experienced finance and claims team with well-defined processes
• We offer generous benefits and a competitive retirement package

• Adapting to constantly evolving federal, state, Medi-Cal, and Medicare claims regulations
• Managing multiple, competing deadlines in a high-volume claims environment
• Providing clear and effective communication when conflicts or discrepancies arise
• Maintaining deep knowledge of complex billing and payment requirements across Medicaid, Medicare, and commercial…