Our team members are the heart of what makes us better.

 

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 Manager of Specialty Services, Claims & Accounts Receivable is responsible for overseeing the full spectrum of billing operations and third-party account follow-up across all facilities within the HMH network. This role ensures that pre-billing, billing, and follow-up processes are executed efficiently, accurately, and in compliance with local, state, and federal regulations, as well as organizational revenue cycle goals. Key responsibilities include managing multiple Supervisors, Analysts, and billing team members and providing strategic oversight of claims submission, electronic data interchange (EDI) transactions, and clearinghouse applications. The Manager leads testing and validation efforts for system upgrades, modifications, and regulatory changes, while ensuring timely and accurate claims processing. Additionally, this role directs third-party follow-up activities across all payers including but not limited to HMO, Blue Cross, Commercial, Government, and Managed Care payers, Specialty and Client billing ensuring accounts are resolved promptly and effectively. The Manager collaborates closely with the Vice President and Patient Financial Service (PFS) Directors to identify operational issues, recommend solutions, and implement initiatives that enhance productivity, maximize cash collections, and improve overall revenue cycle performance.

 

This is a hybrid position - must be in the office one day per week or as needed for mandatory meetings;  the work location can be in Tinton Falls or Hackensack

**Our mandatory meetings take place in the corporate office in Edison.  

 

 

A day in the life of a Manager of Specialty Services, Claims & Accounts Receivable at Hackensack Meridian Health includes:

• Manages daily pre-billing and billing activities for the hospital network including providing guidance and leadership for the supervisor and team members, creates standards of performance in daily work activities; monitors the performance of each team member against these standards.
• Oversees the claims submission processes via the clearinghouse to third party payers in accordance with established policies, state, and federal regulations; this includes responsibility for ensuring all claim files were accepted via payer gateways.
• Responsible for the timely release of all claims from EPIC; follows up with appropriate department leader for issues contributing to delays in claim release. Escalates these issues to the VP and SVP as necessary.
• System Administrator for the billing application/claims scrubber (currently the Assurance Reimbursement Management System); responsible to coordinate training related to any upgrades or enhancements.
• Responsible for ensuring all claim files and payer responses produce and post correctly, including ongoing reconciliation and monitoring of file movement.
• Liaison with Information Technology and the billing vendor support team for any issues or delays that impact timely claim submission to payers and files posting to EPIC.
• Oversees vendors utilized for any specialty billing purposes, including out of state Medicaid, Charity Care & Medicaid, and Worker`s Compensation and No Fault claims.
• Provides input and judgment on medical center committees to ensure compliance with internal and external policies, goals, and regulations.
• Participates in Revenue cycle meetings providing input and analysis for claim issues resulting in denials or payment delays.
• Oversee all billing work queues and dashboard categories in EPIC. Follow up with team members and departments contributing to any delays.
• Provides training and guidance for the analysts responsible for the denial categories managed by the Billing team, including ability to identify root cause and providing a summary presentation to PFS leadership. For example, these are denials for duplicate claim submission and untimely filing.
• Participate in billing/claims testing whenever a new clinical department, service line, or interface is added to ensure revenue safety in EPIC.
• Establishes documented policies and procedures, ensures adherence to such policies and procedures. Responsible for the completeness and ongoing updating of the procedures for all areas of responsibility.
• Keeps Senior Management in Finance informed of any billing related issues.
• Billing issue liaison with other departments including Corporate Compliance, Nursing, and Health Information; responsible for resolution of such issues.
• Establishes Global Billing and Days in A/R goals in accordance with department objectives. Ensures goals and objectives are achieved.
• Responsible for maintaining time and attendance records for the billing team members. Utilize the PeopleSoft and Clairvia system for electronic attendance management and ensure policies are followed by the staff.
• Oversees recruitment and hiring activities; responsible for evaluating, coaching, counseling and termination of staff.
• Maintains current and complete knowledge of applicable Federal and State regulations; maintains thorough knowledge of managed care and third party billing rules, applicable State Department of Health legislature for charity care, information system(s), State or federal legislature regarding collection practices, HIPAA and HCFA rules and regulations and processes connected to the revenue cycle.
• Provides feedback to the Managed Care department regarding contract terms and rates as it relates to billing and collections.
• Interacts with payers on an ongoing basis to resolve account issues and be fully aware of payers` changes and policies.
• Utilizes system-generated monitoring reports as tools for measuring staff performance, billing statistics, and identifying areas for performance and quality improvement.
• Brings any billing issue(s) forward during business office management meetings that would impact other departments and/or changes affecting clinical areas.
• Monitors the status of unbilled and rejected claims. Advises staff, management, or other departments as to the proper course of action to be taken for resolution.
• Monitors reports and conducts analytical reviews to determine where additional emphasis needs to be placed to ensure the goal of timely and proper billing is accomplished.
• Establishes clearly defined productivity targets and goals for the billing team members.
• Identifies system issues that impact the Medical Center`s billing and notifies Information Technology, the Charge Master Coordinator, Clinical Department Head, and/or the billing system vendor as necessary. Brings forward relevant issues to the Revenue Cycle Committee. Assists with the timely resolution of each issue in coordination with any of the involved parties.
• Responsible for overall effectiveness and productivity of operations relating to functions and staff, while also maintaining appropriate staffing levels to accommodate optimal workload for the department.
• Identifies claims/scenarios that are appropriate for testing a new system, new software, an enhancement, or an upgrade to an existing system as necessary; responsible for providing feedback and approvals to Information Technology test results.
• Responsibility for document imaging/scanning functions for Patient Financial Services (PFS).
• Responsible for providing Information Technology with regulatory requirements that must be programmed to ensure claim accuracy.
• Recommends changes and/or appropriate enhancements in the charging system (charge-master/revenue codes) that will make the operations of the Billing Department more efficient and to ensure the proper and timely billing of accounts.
• Responsible for the timely scanning of financial documents, refund requests, EOBs, and the related equipment and maintenance needs.
• Encourages a team environment and staff participation in relevant discussions regarding the performance, as well as maintaining open communication and accessibility for the staff, supervisors and other management.
• Identifies and attends relevant webinars and conferences which could benefit department.
• Develops reporting tools to achieve desired reporting outcomes.
• Establishes realistic standards utilizing best practice benchmarks, develops measurement tools to obtain objective performance measurement; reviews performance in relationship to the standards established.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Education, Knowledge, Skills and Abilities Required:

• BS/BA Degree in Healthcare Administration, Management, Accounting, IT or related field.
• Minimum of three years leadership experience in a healthcare business setting.
• Minimum of three years of Hospital/facility claims experience working in an automated environment.
• Excellent communication, interpersonal, and analytical skills.
• Ability to work in a fast paced and dynamic environment.
• Computer proficiency.

Education, Knowledge, Skills and Abilities Preferred:

• MS/MA/MBA degree.
• Working knowledge of UB/837i Claim specifications and requirements.
• Knowledge of EPIC and/or the Change Healthcare Assurance Claims Scrubber application.

Licenses and Certifications Preferred:

• Healthcare Financial Management Association (HFMA), Coding, EPIC or similar certification.

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

Minimum rate of $131,144.00 Annually

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.

The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to:

Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness.
Experience: Years of relevant work experience.
Education and Certifications: Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training.
Skills: Demonstrated proficiency in relevant skills and competencies.
Geographic Location: Cost of living and market rates for the specific location.
Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization.
Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered.


Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts.

In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.