Manager, Specialty Claims And Accounts Receivable

manager, specialty claims and accounts receivable

hackensack meridian health (hmh), tinton falls, new jersey

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 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, advancing our mission to transform health care and serve as a leader of positive change.

• manages daily pre‑billing and billing activities for the hospital network, providing guidance and leadership for supervisors and team members; creates and monitors performance standards.
• oversees claims submission processes through the clearinghouse, ensuring all claim files are accepted via payer gateways.
• responsible for timely release of all claims from epic; follows up with leaders on delays and escalates issues to vp and svp as necessary.
• system administrator for the billing application/claims scrubber (assurance reimbursement management system); coordinates training for upgrades or enhancements.
• ensures accurate posting of claim files and payer responses, including ongoing reconciliation and monitoring of file movement.
• liaison with it and billing vendor support for any issues affecting timely claim submission and file posting.
• oversees vendors for specialty billing, 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.
• participates in revenue cycle meetings, providing analysis for claim issues resulting in denials or payment delays.
• oversees all billing work queues and dashboard categories in epic; follows up on delays.
• provides training and guidance for analysts responsible for denial categories, including root‑cause analysis and presentation to pfs leadership.
• participates in billing/claims testing when new clinical departments, service lines, or interfaces are added.
• establishes documented policies and procedures, ensuring adherence and ongoing updates.
• keeps senior finance management informed of billing‑related issues.
• bill‑related issue liaison with other departments (corporate compliance, nursing, health information).
• establishes global billing and days‑in‑ar goals, ensuring department objectives are achieved.
• maintains time and attendance records for billing staff using people soft and clairvia; ensures policy compliance.
• oversees recruitment and hiring activities; evaluates, coaches, counsels, and terminates staff.
• maintains current knowledge of federal and state regulations and managed‑care billing rules.
• provides feedback to the managed care department regarding contract terms and rates related to billing and collections.
• interacts with payers to resolve account issues and stay informed of policy changes.
• uses system‑generated monitoring reports for staff performance and billing statistics.
• brings billing issues to management meetings that could impact other departments.
• monitors status of unbilled and rejected claims; advises on resolution action.
• conducts analytical reviews to identify improvement areas for timely and proper billing.
• establishes productivity targets and goals for the billing team.
• identifies system issues affecting billing; notifies it, charge master coordinator, and billing vendors; brings forward relevant issues to the revenue cycle committee.
• maintains overall effectiveness and productivity of billing operations and staffing levels.
• identifies scenarios requiring system testing; provides feedback and approvals to it.
• manages document imaging and scanning for patient financial services.
• communicates regulatory requirements to it for claim accuracy.
• recommends changes to the charging system to improve billing efficiency.
• ensures timely scanning of financial documents, refund requests, eobs, and related equipment maintenance.
• encourages a team environment and staff participation; maintains open communication.
• attends relevant…