Capital Health is the region's leader in providing progressive, quality patient care including advanced technology and a wide network of primary and specialty care providers.
This full-time day position is responsible for administrative management, tracking, and coordination of outpatient clinical denials including medical policy denials, experimental or investigational determinations, and other payer clinical criteria denials. The role ensures proper triaging, routing, documentation, tracking, and appeal preparation for outpatient clinical denial cases, working collaboratively with clinical and operational teams to support resolution and denial prevention.
The pay range is $20.10 - $26.13 per hour with a 40-hour workweek.
Key responsibilities include review and triage of outpatient clinical denials, routing cases to appropriate clinical resources, maintaining denial inventories, coordinating medical record requests and appeal preparations, ensuring compliance with payer requirements and timelines, payer follow-up via portals and calls, documenting denial actions and status, identifying denial trends for escalation, supporting denial prevention initiatives, and maintaining current knowledge of payer policies and appeal processes.
- High school diploma or equivalent required; Associate or Bachelor's degree in healthcare or business preferred.
- Minimum three years' experience in hospital billing, denials management, utilization review support, or related revenue cycle experience.
- Preferred experience with outpatient clinical denials or medical necessity line-item denials.
- Working knowledge of outpatient clinical denial categories including medical policy, experimental/investigational, and clinical criteria denials.
- Familiarity with payer authorization processes and outpatient clinical documentation workflows.
- Strong organizational skills, attention to detail, and ability to perform detailed tracking and documentation.
- Strong written communication skills.
- Proficiency with hospital billing systems, EMR navigation, and payer portals.
- Ability to meet deadlines, demonstrate good judgment, and be metric-driven and results-oriented.
- Medical, Prescription Drug, Dental, and Vision Plans
- Flexible Spending Account (Healthcare and Dependent Care)
- Retirement Savings and Investment Plan
- Basic and Supplemental Group Term Life and Accidental Death & Dismemberment Insurance
- Short and Long Term Disability Benefits
- Employee Assistance Program
- Commuter Transit and Parking
- Voluntary Life and Legal Services
- Voluntary Accident, Critical Illness, Hospital Indemnity, Identity Theft, and Pet Insurance
- Paid Time-Off Program
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 week ago