Job Abstract

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 Manager, Reconciliation/Remit Management, PB is responsible for daily operations, management, financial and efficient performance of Cash Posting and Reconciliation department. Directly manages the payment, adjustment, denial posting and processing of credit balances functions, assuring timely posting of transactions to the patients' accounts to ensure lowest possible days in accounts receivable in a cost effective manner and timely billing of NRP (next responsible party). Supports the Revenue Cycle team to achieve the established KPI & metrics for the revenue cycle. Creates and utilizes reports that are used as tools for trending and analysis for various areas of the Revenue Cycle. Serve as subject matter expert in EDI 835 transactions, oversee all activities related to implementation, change and revision of 835 transactions. This position is responsible for identifying for management, issues and recommendations needed to increase cash flow and prevent accounts receivable from aging, prevent denials, by which accounts receivable would be reduced and effectively managed. Acts as a change agent - capable of guiding teams in initiating various change management initiatives. Duties performed are at multiple sites within the Hackensack Meridian Health (HMH) Network.

Responsibilities

A day in the life of a Manager, Reconciliation/Remit Management, PB at Hackensack Meridian Health includes:

• Performs duties which guide the management of the payment, adjustment and denial posting and processing of credit balances functions of the business office.
• Manages department performance as it relates to the daily payment, adjustment and denial posting and processing of credit balances which is critical in achieving organizational goals. Ensure cash optimization and accounts receivable reduction activity is functioning to the fullest capability.
  • Cash Received and File - Ensure that daily cash received is reconciled with the file received. Daily balancing has to occur and monthly reconciliation with Finance has to be timely for it affects the financial monthly close.
  • Denials are posted and routed to the appropriate area timely.
  • Manual adjustments are performed accurately, ensuring balance is NRP correctly.
• Establishes realistic functional standards utilizing best practice standards as benchmark.
• Oversees the processing of overpayment for Patient and Insurance.
  • Ensure that the proper policies and procedures in processing refund are followed.
  • Approved all refunds and retraction for Patient and Insurance.
  • Automate process for refund - streamline and ensure all levels of approval are being followed.
  • Monitors credit balance and dashboard and conducts analytical reviews to determine where additional emphasis needs to be placed to ensure the goal of timely and proper processing of transactions to patients' accounts.
  • Manage On-Site Payer Auditors
  • Develop DeskTop Procedures
  • Respond to Internal & External audit due to overpayment
• Work closely with the bank to automate and maintain Lockbox, Correspondence and patient portal as seamless as possible. Converts all current EOB (explanation of Benefits) that are neither 835 payers nor process through the lockbox as an 835 file. Stay current with new developments in the market regarding new products and Fraud detection newsletters.
• Develop a business relation with the payer representative and their EDI lead person, this will expedite resolution of urgent problems and stop it from recurring. Collaborate with the Clearing House to ensure seamless flow of 835 Files.
• Develops and implements quality assurance measurements and standards, including completion of internal and external audits. Responsible for yearly external audit by PWC (or other entity engaged to conduct the yearly audit) as it relates to Revenue Operations related questions. Respond to payer audit requests.
• Audit manual adjustment performed by Revenue Operations staff to determine if there is an issue that needs to be addressed. Perform staff audit to ensure allowance or balance are being done correctly and the team is in compliance with the set guidelines of processing debit or credit variance.
• Collaborate with the Training department if process change has to be developed based from discovery, new technology, change in payer rules or change in internal process.
  • Handles the development of reporting tools for management utilizing the current information system and/or identifying other software programs to achieve desired reporting outcomes.
  • Requests, obtains, and distributes monitoring reports (ad hoc), Reporting Workbench, Radar, BI reports to the appropriate leaders and supervisor the ultimate delegation to review and subsequent staff assignment.
  • Performs data mining and in depth analysis of root cause of payment variance or denial.
• Manages Denial DashBoard for the HMH Network with Primary oversight for the strategic decision making for all automation of process. Achieved through:
  • Investigation and resolution of problems to ensure coordinated efforts; works closely with the Revenue Cycle Department to mitigate AR aging & Denials.
  • Building of strong working relationships with applicable parties within HMH and external vendors.
  • Manage Governmental denials - work closely with Case Management, Utilization Review, Physician Advisors, Registration/Access & other departments that have impact on Denials.
  • Identify variables in getting full payments & recommend solutions to accelerate cash flow.
  • Manage all DashBoards related to Revenue Operation, aside from the AR Summary section, the Watchlist section needs to be monitored.
• Performs duties which guide the management of the under/over payments, adjustment and denial posting and processing of credit balances functions of the business offices for the HMH Network.
  • Manages department performance as it relates to the daily payment, adjustment and denial posting and processing of credit balances.
  • Ensures that Reconciliation WQ's are maintained at less than seven days to ensure smooth flow of accounts in the Revenue Operations.
  • Ensure that Contract Management is loaded timely, rate sheets are current this is crucial in preventing accounts aging on the Reconciliation WQ's.
  • Building of strong working relationships with IT (Information technology) to expedite resolution pertaining to Contracts. Stay on top of Contract loading & renewal to avoid variance volume in Reconciliation WQ. Thorough testing in accordance with policies and practices
  • Ensures Contract Management is working efficiently. Ensures it is and is updated with the current Fee schedule. Ensures current versions of DRG, APC, and bundling rules are in place.
  • Current on payer trends, rules and regulations by Medicare, Medicaid and Commercial Payers.
  • Manage all payer websites needed by the team to adjudicate accounts are in place.
  • Establish a regular meeting with the payer representative in order to resolve and/o escalate payment variance.
• Manages the Reconciliation & Remittance team to ensure all policies & procedures are followed
  • Workflow implementations, desktop procedures & departmental policies & procedure creation & implementation.
  • Training of new employees or as new policy is created.
  • Understanding of financial impacts tied to management of project timelines.
  • Collaboration with the corporate finance team to ensure understanding of revenue cycle transactions as well as proper revenue cycle financial reporting. Develops and implements quality assurance measurements and standards, including completion of internal and external audits.
• Develops, revises, publishes, and monitors reports to support the Revenue Cycle team. Includes, but is not limited to Daily Cash reports, Monthly & Yearend Cash reports. Where necessary, implement corrective action plans. Maintains strong relations with the Accounting & Reimbursement team.
• Disseminates and communicates policy changes and guidelines from the payers.
• Works collaboratively with Revenue Cycle Training Manager to design, develop and administer educational training programs.
• Recruits and selects talent and manages staff . Formally evaluates performance and professional development of staff. Performs disciplinary actions where necessary.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Bachelor's degree or finance related area of concentration or business administration with concentration in finance or management or equivalent experience.
• Minimum of 4 or more years of experience in Healthcare/Billing/Collections/Revenue Cycle.
• Minimum of 3 or more years in managerial role.
• Proficiency with Windows applications, particularly in Excel, as well as Hospital Billing systems, SMS and EPIC.
• Strong report writing skills, outcome driven and technology savvy.
• Strong knowledge of healthcare industry revenue integrity key performance indicators and best practices.
• Change agent, capable of guiding teams in initiating change management initiatives with the view of leading and guiding towards the future, but respectful of organizational history and culture.
• Strong multi-tasking skills and the ability to work at multiple facilities.
• Ability to gather complex data, compile usable information and prepare report that are understandable by members of the organization.

Licenses and Certifications Required:

• EPIC Resolute Professional Billing - Cash Posting and Credit Management upon hire or obtain within 6 months of hire.
• EPIC Resolute Professional Billing - Electronic Remittance upon hire or obtain within 6 months of hire.
• EPIC Resolute Professional Billing - Billing Administration (non-SBO) upon hire/obtain within 6 months of hire.
• EPIC Reporting Workbench/Cogito & Radar Certs - upon hire or obtain within 6 months of hire.
• Must successfully pass completion of EPIC assessment within 30 days after Network access granted.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

Our Network

Hackensack Meridian Health (HMH) is a Mandatory Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.