Hackensack Meridian Health · 1 month ago
Manager, Specialty Claims and Accounts Receivable
Tinton Falls, NJ
Full-time
Hybrid
Mid, Senior Level
3+ years expHackensack Meridian Health is committed to transforming healthcare and serving as a leader of positive change. The Manager of Specialty Services, Claims & Accounts Receivable is responsible for overseeing billing operations and third-party account follow-up, ensuring compliance with regulations, and leading a team to improve revenue cycle performance.
Assisted LivingHealth CareHealth DiagnosticsHospitalMedical
Responsibilities
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
Qualification
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
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
Healthcare Financial Management Association (HFMA), Coding, EPIC or similar certification
Benefits
Health
Dental
Vision
Paid leave
Tuition reimbursement
Retirement benefits
Company
Hackensack Meridian Health
Hackensack Meridian Health is a health care organization that offers research and medical services.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$36.3MKey Investors
Baldrick's FoundationNational Institutes of Health
2023-11-21Grant
2023-02-24Grant· $3M
2019-05-10Grant· $33.3M
Leadership Team
Robert C. Garrett
Chief Executive Officer
Michael Allen
President, Financial Services Division and CFO
Recent News
bloomberglaw.com
2026-01-20
2025-12-15
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