Manager, Appeals (Full- Time) Remote- Hybrid

Our Denial Management Recovery Services division is crucial to our company's success. The Manager of the Appeals team within RWJBarnabas healthcare facilities manages technical and clinical denials, working to resolve them and obtain optimal reimbursement. This role collaborates with Case Management and Centralized Scheduling to ensure compliance with the denial/appeal process. This position supports communication with third-party payors to resolve billing discrepancies, handles audit and compliance responsibilities, and performs administrative duties as needed.

Qualifications:

• Bachelor's degree in Finance, Healthcare, or related field
• Minimum five years' managed care appeal experience
• Experience in denials and appeals management
• Excellent interpersonal, oral, and written communication skills
• Strong organizational and time management skills
• Project management, problem-solving, and analytical skills
• Knowledge in measurement analysis and communication
• Proficiency in Microsoft Office, especially Excel
• Ability to work independently and in a team

Essential Functions:

• Critical thinking, problem-solving, and independent decision-making
• Organize workflow to address denials per departmental standards
• Develop action plans and process improvements
• Maintain training documentation
• Generate monthly reports analyzing denial trends
• Identify denial patterns and educate staff to prevent future issues
• Research payer denials related to referrals, pre-authorizations, and medical necessity
• Verify accuracy of denial reasons and codes
• Create appeals based on dispute reasons and contract terms, including online reconsiderations
• Follow payer guidelines for appeal submissions
• Escalate unresolved appeals
• Research contract terms and compile documentation for appeals and overpayment issues
• Participate in payer projects as assigned
• Foster effective departmental relationships for root cause analysis
• Review accounts and advise management on non-collectible accounts

Other Duties: This job description is not exhaustive; duties may change at any time with or without notice.

Additional Information: Our comprehensive benefits include PTO, medical, dental, vision, retirement plans, disability, life insurance, tuition reimbursement, flexible spending accounts, wellness programs, voluntary benefits, and partner discounts. RWJBarnabas Health is committed to providing high-quality, patient-centered care and a supportive work environment. We aim to improve community health and create educational and career opportunities across New Jersey. RWJBarnabas Health is an Equal Opportunity Employer.