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At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Director of Patient Financial Services for Claims Management provides management of pre-billing and billing functions for inpatient, outpatient, and specialty areas across the Hackensack Meridian Health (HMH) network. Provides management, coordination, and standardization of claims production and transmission for all payers in HMH hospital billing, impacting the primary source of revenue for the network. Develops and controls all tasks necessary to ensure that all billing activities are completed compliantly and on time. Responsible for oversight and administration for the Epic claims editor and clearinghouse application, including all related electronic data interchange (EDI) transactions. Develops and maintains strong payer relationships to remove barriers to claim creation and submission and works through any issues that arise. Identifies issues and recommends possible solutions to increase productivity, maximize cash collections, and improve the revenue cycle. Supports the success of a high-performing business office by helping to champion and drive long-term success, achieving results comparable to national best practices.

A day in the life of a Director of Patient Financial Services for Claims Management at Hackensack Meridian Health includes:

• Oversight across the HMH Network of all pre-billing, billing, and claims submission activities for Hospital Billing, ensuring that all claims are successfully and cleanly transmitted and accepted via payer gateways.
• Responsible for the timely release of all claims from Epic, monitoring all claims in a Candidate for Billing status, resolving issues with the owning department, and escalating any issues to the VP as necessary.
• Oversee all billing work queues and dashboard categories in Epic. Follow up with departments contributing to any billing delays.
• System Administrator for the claims clearinghouse and its interactions with Epic to edit claims and release clean claims to payers; ensures required enrollments are maintained.
• Oversight and development for specialty billing functions including Research and Grant based programs, Global transplant, Cosmetic and Self-pay procedures, Hospice, and Epic Bundled and Client billing.
• Primary contact for Epic Hospital Billing - Claims for optimization, training, and testing for upgrades or enhancements.
• Ensure that claims submitted to payers are free from errors that would produce rejections, non-payment, short payment, or denials. Monitor clean paid claims rate to build review processes or claim corrections to decrease or eliminate errors producing delayed or reduced payments.
• Liaise with Digital Technology Services (DTS) and the clearinghouse vendor support team for any issues or delays that impact timely claim submission to payers and file posting to Epic.
• Ensures all claim files and payer responses produce and post correctly, including ongoing reconciliation and monitoring of file movement.
• Manages vendors utilized for any specialty billing purposes, including out-of-state Medicaid and Worker's Compensation & No-Fault claims.
• Ensure rigorous billing/claims testing whenever a new clinical department, service line, or interface is added to ensure timely claim resolution.
• Develop best-in-class claims processes by staying abreast of the current state of the art with people, processes, and technology. Develop key metrics and benchmarks externally to ensure continued best practice results.
• Act as a liaison for hospital billing/claims with other departments, including but not limited to corporate compliance, nursing, and health information.
• Establishes documented policies and procedures and ensures adherence to such policies and procedures. Responsible for the completeness and ongoing updating of the procedures for all areas of responsibility.
• Establishes clearly defined productivity targets and goals for the billing team members. Monitor that team members are meeting such targets and remove barriers for team members to exceed target results.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Education, Knowledge, Skills and Abilities Required:

• Bachelor's degree in Business, Healthcare Administration, Finance, or other relevant field.
• Minimum of 10 years of experience in healthcare receivables, health insurance claims processing, or healthcare customer service, including at least 5 years in a management role.
• Extensive knowledge of Federal and State regulations and mandates relating to patient self-pay collections.
• Excellent customer service acumen
• Strong leadership skills.
• Good written and verbal communication skills.
• Strong financial management skills.
• Excellent knowledge of information technology and management information systems and how they can be used to improve operations.

Education, Knowledge, Skills and Abilities Preferred:

• Master's degree.
• Prior experience with Epic.
• Management of a claims & clearinghouse application.
• Experience working in a hospital billing setting.
• Member of nationally recognized professional organization - Healthcare Financial Management Association (HFMA) a plus.

Licenses and Certifications Preferred:

• HFMA Certified Healthcare Financial Professional (CHFP) or similar certification
• Epic proficiency or certification in hospital billing (HB)/Claims.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!