Supervisor, Specialty Claims & Accounts Receivable

Hackensack Meridian Health•Tinton Falls, NJ

About The Position

The Supervisor of Specialty Claims & Accounts Receivable at Hackensack Meridian Health (HMH) 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 supervising, analysts, and billing team members and providing strategic oversight of claims submission, electronic data interchange (EDI) transactions, and clearinghouse applications. The supervisor monitors system upgrades, modifications, and regulatory changes, while ensuring timely and accurate claims processing. Additionally, this role supervises 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 supervisor collaborates closely with the department manager and other HMH stakeholders to identify operational issues, recommend solutions, and assist with the implementation of initiatives that enhance productivity, maximize cash collections, and improve overall revenue cycle performance.

Requirements

Bachelor's degree; or equivalent relevant experience at 4 years or more.
Minimum of 4 years' experience in healthcare billing or health insurance claims environment. Familiar with medical billing practices, concepts, and procedures.
Excellent analytical and critical thinking skills with attention to detail.
Ability to work in a fast paced business office; must be able to coordinate multiple projects with multiple deadlines or changing priorities.
Prior experience with an electronic billing system/claims editor.
Proficient with computer applications and spreadsheets.
Must be highly organized and possess excellent time management skills.
Strong written and verbal communication skills.
Excellent written and verbal communication skills.
Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms.

Nice To Haves

Proficiency with Epic Hospital Billing, claims, and Assurance Reimbursement management.
Prior experience in a Patient Financial Services Department for a University Medical Center/hospital.
Experience with supervision and delegating tasks.
Extensive understanding of inpatient and outpatient hospital billing practices.
Experience with understanding and applying logic to claim rejections, edits, and errors.
Experience with EPIC and Assurance a plus, Real Time Eligibility tools, payer portals.

Responsibilities

Monitor daily pre-billing, billing and follow up operations across HMH network, providing leadership and guidance to analysts 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.
Assist in the creation of productivity benchmarks and monitor individual and team productivity to ensure operational efficiency and identify opportunities for improvement.
Monitor 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. 11. 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.
Assist 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.
Monitor 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.
Provides training and support to team analysts, specialist and representative 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.
Monitor vendor productivity; 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; time keeping, 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 and department leadership team.
Performs other duties and special projects as assigned to support departmental and organizational goals.
Adheres to HMH organizational competencies and standards of behavior.