Denials & Appeals Manager

The Denials & Appeals Manager will be r esponsible for r eviewing physicians clinical documentation to appeal, and identify denial trends based on medical necessity, underpayments and present resolution with the goal of clinical denial reduction. This role will identify denials trends based on medical necessity, underpayments and presenting resolutions with the goal of denials reduction. Review adverse determinations and claims to assist in the identification of denials and timely appeal referral with the goals of procuring reimbursement as well identifying denial root cause. Primary Responsibilities: Reporting: Denials assists with preparing reports as needed (daily/weekly/monthly) Reports of weekly denials submitted for agency appeal Utilized ACM and monthly agency data for denials and appeals reports as requested by department heads and various committees. Denials and Approvals Correspondence: Review payer correspondences including adverse determination letters, payer End of Day Reports (EDOR), authorization and appeal response letters received via mail or scanned by Case Management. Utilize ACM and Case Management peer-to-peer log for most updated documented authorization status. Review claims to identify clinical, technical denials Ensure timely appeal referral with the goals of procuring reimbursement Requirements

Bachelor's Degree required Preferred clinical experience in a hospital/healthcare setting Union Position

Non-Union Regular or Temporary

Regular Salary Type (FLSA)

Exempt Salary Range

95,000 Position Type

Full-time Position Number

IL055202 Home Department

Shift

About the company

St Barnabas Hospital is a non-profit hospital founded in 1866. Notice

Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000. Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility. An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report . NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000. #J-18808-Ljbffr