Overview

How have youimpactedsomeone's life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of careeach and everyday.From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career, all within New Jersey's premier healthcare system. 

At Hackensack Meridian Health at Home, we recognize our full- and part-time benefit eligible team members by offering a Total Rewards package including comprehensive Health Benefits , generous Paid Time Off , Travel Reimbursement as well as an investment in your future with a 401(k) match and Tuition Reimbursement. Per Diem team members are eligible toparticipatein the 401(k) match and Travel Reimbursement . At www.TeamHMH.com ,you’llfind the information, resources and tools that will help you to be successful at HMH.From great benefits and innovative wellness programs,to robust learning and development opportunities, we continue to cultivate an exceptional work environment where you can do the kind of work that leads to fulfillment and professional growth.

Responsibilities

The Manager, Billing, Infusion and DME will identify reimbursement issues and ensure claims, denials and appeals are processed efficiently and timely. This position will manage domestic and global teams. This position will manage workflow and resolve problems to achieve peak productivity, as well as train, motivate, and supervise team members for optimal performance to achieve our revenue goals and maximize cash flow.

• Develops and maintains working knowledge of current Infusion and DME products and services offered by Hackensack Meridian Health At Home. Collaborates with Sales, Respiratory, Pharmacy and Nursing Departments on new product/therapy offerings and provides support to investigate coverage guidelines for all contracted payers. Maintains expert knowledge of all reimbursement billing procedures, regulations and policies of third party, private insurance, and government payers to ensure compliance with current processes for Home Infusion and DME.

• Performs regular analytical review of open receivables to maximize collections, minimize DSO, write-offs and bad-debt. Regularly reviews open AR for Home Infusion and DME to provide focused descending balance reports and key accounts for collections follow-up by AR Coordinators. Provides regular feedback and expectations to the staff.

• Responsible for billing issue resolution. Identifies denial trends and other payment discrepancies and escalates resolutions with payer contacts and to divisional leadership for awareness. Ensures proper claims corrections are resubmitted timely to insurance payers. Works with Billing & Collections Coordinators to ensure timely follow-up on open accounts receivable.

• Maintains direct responsibility for oversight of Revenue Cycle Management employees and offshore staff as needed to ensure all RCM functions are completed within the established timeframes. Strategically delegates appropriate activities to offshore staff to optimize RCM efforts.

• Ensures nightly claims submissions occur for all payers for Home Infusion and DME on all EMR Systems. Assigns staff to follow-up on clearinghouse claim rejections. Ensures the correct and accurate coding of all products and services billed.

• Responsible for overseeing cash applications. Ensures timely receipt and processing of lockbox and credit card payments to the appropriate EMR system(s). Ensures EMR systems balance and match bank/credit card merchant account deposits.

• Responsible for coordinating the submission of prior authorization initial and renewal requests as necessary for DME and Infusion claims. Monitors outstanding authorization requests and ensures staff responsible for submission of requests are directed accordingly to ensure timely submission of all requests.

• Responsible for conducting weekly reviews of claims on the stop/hold report/work queue, and for directing the staff responsible for resolution of these claims to ensure that all claims on hold/stop are processed and released within payer timely filing limits. Oversees the document procurement process to ensure refill prescriptions are obtained timely and within payer timely filing limits. Intercedes on behalf of staff to address and disposition. Maintains held revenue at or below industry benchmarks for DME and Infusion.

• Oversees the management of all incoming payer audit requests, including but not limited to CERT Audits, RAC requests, pre-payment audit requests and post-payment audit requests. Coordinates and assigns staff to retrieve necessary documentation and draft audit response. Reviews all audit correspondence before submission to payers for accuracy and completeness.

• Maintains accurate payer contracts reference and ensures the timely and accurate maintenance and entry of pricing tables into the respective EMR(s). Audits claims/price tables to ensure EMR system(s) are accurately billing and booking AR according to current payer contracts.

• Maintains personnel, health files and compliance records for home infusion and DME staff in accordance with regulatory guidelines and company policies.

• Oversees facility and wholesale billing process for DME and Infusion. Ensures monthly invoices are accurate and transmitted/received by wholesale and facility accounts. All internal HMH accounts are processed accordingly with finance for inter-company transfers and posted for month-end close. Reports unpaid wholesale accounts 60+ days aged to General Manager and Director of Pharmacy for collections escalation.

• Responds to correspondence, email and voicemail on a daily basis and consistent with HMH policies. Assures messages/issues are resolved and correspondence is worked daily.

• Adheres to HMH¿s Organizational competencies and standards of behavior.

• Lifts a minimum of 10 lbs., pushes and pulls a minimum of 10 lbs. and stands a minimum of 2 hours a day.

• Other duties and/or projects as assigned. Demonstrates flexibility with job responsibilities in all areas.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Associate's degree.

• Minimum of 4 years of experience in Durable Medical Equipment and/or Home Infusion billing & collections.

• Strong analytical and problem-solving skills with attention to detail.

• Excellent verbal and written communication

• Excellent customer service skills.

• Ability to prioritize and manage multiple projects.

Education, Knowledge, Skills and Abilities Preferred:

• Bachelor's degree or higher.

• 3 or more years relevant management experience in health care administrative, financial, insurance customer services, claims, billing.

• Working knowledge of medical terminology.

• Home Infusion and/or Home Medical Equipment experience.

• Experience with Google Suite platforms.

Job ID 2024-153541

Department DME south

Site Health Innovations Unlimited

Job Location US-NJ-Eatontown

Position Type Full Time with Benefits

Standard Hours Per Week 40

Shift Day

Shift Hours 8:30am - 5:30pm

Weekend Work No Weekends Required

On Call Work No On-Call Required

Holiday Work No Holidays Required