Manager, Specialty Claims And Accounts Receivable

Overview

Manager, Specialty Claims and Accounts Receivable — Hackensack Meridian Health (HMH). This is a full-time role in Patient Financial Services (PFS) - Claims Management, overseeing 2 direct reports and approximately 20 team members in total. Hybrid role requiring one day per week in Edison, NJ for mandatory meetings.

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives and support one another to succeed. We are committed to collaboration, competitive benefits, and community impact. This position is responsible for overseeing the full spectrum of billing operations and third-party account follow-up across all facilities within the HMH network, ensuring pre-billing, billing, and follow-up are efficient, compliant, and aligned with organizational revenue cycle goals.

The Manager leads testing and validation for system upgrades, manages system-wide claims submission and EDI transmission, and directs third-party follow-up across payers including HMO, Blue Cross, Commercial, Government, and Managed Care. This role collaborates with the Vice President and PFS Directors to identify issues, implement solutions, and improve revenue cycle performance.

• Manage daily pre-billing, billing, and follow-up operations across the HMH network; provide leadership to supervisors and team members.
• Monitor Epic dashboards, reports, and analytics to track aged receivables and support resolution strategies; ensure goals are achieved.
• Establish productivity benchmarks and monitor individual and team performance; identify opportunities for improvement.
• Oversee claims submission via clearinghouses to third-party payers; verify acceptance of claim transmission and timely posting to EPIC.
• Ensure timely release of claims, investigate delays, and escalate unresolved issues as needed.
• Serve as primary point of contact for facility and finance leaders regarding PFS inquiries and performance metrics.
• Lead regular revenue cycle performance meetings with key stakeholders; develop action plans with PFS and facility departments to address gaps and reduce denials.
• Build and maintain collaborative relationships with PFS staff, department managers, clinical leaders, and finance teams.
• Identify opportunities for front-end, mid-cycle, and back-end process improvements to prevent revenue leakage; track progress and impact of solutions.
• Communicate performance trends, challenges, and successes to department leadership.
• Act as system administrator for billing applications and scrubbing tools; coordinate training and upgrades.
• Assist with claim testing, identify scenarios for testing new systems or enhancements, and provide feedback to IT based on results.
• Coordinate with IT and billing vendors to address system issues affecting submissions and postings; participate in IT meetings for automation initiatives.
• Oversee specialty billing vendors (e.g., out-of-state Medicaid, Charity Care, Medicaid, Workers’ Compensation, No Fault).
• Manage EPIC billing and follow-up work queues and dashboards; ensure timely follow-up and resolution of items.
• Track payer activity, resolve discrepancies, and improve payment timeliness through meetings with provider representatives.
• Provide training and support to team analysts and supervisors; prepare data-driven presentations for leadership.
• Coordinate Revenue Operations meetings and Facility Committees; offer insights to improve billing and follow-up accuracy.
• Manage vendor productivity and aging reports; perform adjustments and reconciliations as needed.
• Resolve payer disputes and rejections across all payer plans; respond to requests for information and audits; address complex payment issues.
• Oversee performance evaluations, onboarding, and staff development.
• Maintain current knowledge of payer policies, procedures, and regulatory requirements.
• Ensure timely scanning of financial documents and manage related equipment and maintenance needs.
• Coordinate educational programs for team members with the HMH training team.
• Perform other duties and special projects as assigned to support departmental and organizational goals.