Hackensack Meridian Health · 11 hours ago
Manager, Specialty Claims and Accounts Receivable
Tinton Falls, NJ
Full-time
Hybrid
Mid, Senior Level
$131K/yr - $131K/yr
5+ years expHackensack Meridian Health is dedicated 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 across all facilities, ensuring compliance and efficiency in claims processing.
Assisted LivingHealth CareHealth DiagnosticsHospitalMedical
Responsibilities
Manages daily pre-billing, billing and follow up operations across HMH network, providing leadership and guidance to supervisors and team members
Daily monitoring of Epic Dashboards (DNBs, Candidate for Billing (CFB)), Workbench reports and Slicer/Dicer reports to track aged receivables and support account resolution strategies in accordance with department objectives. Ensure goals and objectives are achieved
Establishes productivity benchmarks and monitors individual and team productivity to ensure operational efficiency and identify opportunities for improvement
Oversees claims submission processes via the clearinghouse to third-party payers, ensuring compliance with internal policies and federal and state regulations. Verifies acceptance of claim file transmission through payer gateways and ensures accurate and timely posting to EPIC
Ensures timely release of claims from EPIC, investigates delays, and escalates unresolved issues to senior leadership as appropriate
Act as the primary point of contact for facility and finance leaders regarding all PFS-related inquiries, escalations, and performance metrics
Schedule, prepare for, and lead regular revenue cycle performance meetings with key stakeholders
Partner with PFS and facility departments including but not limited to (e.g., patient access, health information management, case management, CDM team) to develop and implement action plans to address performance gaps and reduce denials
Build and maintain strong, collaborative relationships with PFS staff, department managers, clinical leaders, and the finance team
Identify opportunities for process improvement at the front-end (registration, insurance verification), mid-cycle (charge capture, coding), and back-end (billing, collections) to prevent revenue leakage
Track the progress and impact of implemented solutions to ensure sustained improvement
Effectively communicate performance trends, challenges, and successes to department leadership
Serves as system administrator for billing applications and claims scrubbers, coordinating training and implementation of upgrades and enhancements
Assists with claim testing, 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 (IT) based on test results
Acts as liaison with IT and billing vendors to address system issues affecting claim submission and file posting
Engages in IT meetings to support automation initiatives and process improvements
Oversees specialty billing vendors, including but not limited to those handling out-of-state Medicaid, Charity Care, Medicaid, Worker's Compensation, and No Fault claims
Manages EPIC Billing and Follow up work queues and Dashboards, ensuring timely follow-up and resolution of outstanding items
Track payer activity for partial payment and non-payment trends; Facilitate meetings with provider representatives to resolve payer related discrepancies and improve payment timeliness
Monitors follow-up reports and conducts analytical reviews to identify areas requiring focused collection efforts
Manages, provides training and support to team analysts and supervisors, guiding root cause analysis and preparing presentations for Patient Financial Services leadership with actionable data and insights
Coordinates, facilitates and or participates in Revenue Operations meetings and Facility Committees, offering insights and recommendations to improve billing and follow up accuracy to reduce denials
Manage vendor productivity; Monitor aging reports, escalates unresolved issues, performs adjustments and coverage updates on self-pay transfers, and reconciles vendor reports for accuracy
Resolves payer disputes and rejections across all payer plans including but not limited to (e.g.,HMO, Blue Cross, Government, Commercial and Managed Care), ensuring timely and accurate billing and follow-up
Responds to payer requests for additional information, medical records, audits problem accounts, and resolves complex payment issues
Manages performance evaluations for team members; promotions, disciplinary actions, and onboarding activities
Maintains current knowledge of applicable payer policies, procedures, and regulatory requirements
Tracks payer activity for partial and non-payment trends; Facilitate meetings with Provider Representatives to resolve discrepancies and improve payment timeliness
Responsible for timely scanning of financial documents, refund requests, EOBs and the related equipment and maintenance needs for Patient Financial Services
Coordinates educational programs for team members in partnership with HMH training team
Performs other duties and special projects as assigned to support departmental and organizational goals
Other duties and/or projects as assigned
Adheres to HMH Organizational competencies and standards of behavior
Qualification
Required
Bachelor's degree; or equivalent relevant experience at 4 years or more
Minimum of 5+ years of experience plus prior management experience in healthcare accounts receivable to health insurance receivable environment
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
Excellent written and verbal communication skills
Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms
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, and 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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