Job Information
Hackensack Meridian Health Manager of Physician Billing Network - Patient Accounts in Hackensack, New Jersey
Overview
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 to 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.
Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.
The Physician Enterprise/ Network Manager - Patient Accounts is responsible for pre-billing and billing functions for all Physicians located across the Hackensack Meridian Health (HMH) network. Processes to be performed in compliance with established goals, revenue cycle activities, and regulations. Manages the supervisor and billing team members. Responsible for oversight and administration for the claims editor and clearinghouse application, including all related electronic data interchange (EDI) transactions. Performs testing and validation for upgrades, system modifications and regulatory mandated changes. Ensures claims are submitted timely and accurately in compliance with local and federal regulations. Assists the Professional Division Network Directors and EVP with identifying issues and recommends possible solutions to increase productivity, maximize cash collections, and improve the revenue cycle. Load and manages EPIC's Contract Management Module for professional Physician negotiated contracts, medicare and medicaid fee schedules and all other contractual arrangements for physician services.
Responsibilities
A day in the life of a Manager, Hospital Billing - Physician Billing at Hackensack Meridian Health includes:
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 Network Director and EVP as necessary.
System Administrator for the billing application/claims scrubber (currently the OLIVE 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 practice, billing area, 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, practice Directors and Managers, 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 the 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.
Qualifications
Education, Knowledge, Skills and Abilities 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/Professional 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.
A good understanding of third party payer contracts and how to interpret.
Excellent written and verbal communication skills.
Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms.
Education, Knowledge, Skills and Abilities Preferred:
MS/MA/MBA degree.
Working knowledge of UB/837i Claim specifications and requirements.
Knowledge of EPIC and/ an electronic clearing house and Scrubber application.
Licenses and Certifications Preferred:
Healthcare Financial Management Association Certification.
EPIC Hospital Billing and Contract Management.
If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!
Job ID 2024-150417
Department PB Network Access Services
Site HMH Physician Services, Inc.
Job Location US-NJ-Hackensack
Position Type Full Time with Benefits
Standard Hours Per Week 40
Shift Day
Shift Hours Day
Weekend Work Weekends as Needed
On Call Work No On-Call Required
Holiday Work No Holidays Required