RWJBarnabas Health
Job Title: Data Analyst
Location: System Business Office
Department Name: Appeals
Req #: 0000220243
Status: Salaried
Shift: Day
Pay Range: $62,476.00 - $88,248.00 per year
Pay Transparency The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.
The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.
Job Overview The DataAnalyst, Appeals is primarily responsible for validating clinical and technical denials to ensure appeals are accurately pursued. Daily work includes ordering medical records, entering denials, and calling payers to gather account information as well as appeal outcomes. In this role, you would be responsible for formulating and submitting the appeal for out-patient no authorization/ medical necessity denials.
Qualifications Required:
HS diploma or GED equivalent.
2+ years working for hospitals or payers in a similar capacity.
Proficient in medical terminology and knowledge of commercial insurance.
Microsoft Office
Microsoft Excel skills required.
Preferred:
Associate’s degree in business or finance preferred.
Scheduling Requirements
Full-Time, Salaried position– 40 hours a week
Travel to Oceanport, NJ as needed
MUST be located in NJ, NY, or PA
Essential Functions
Confidentiality - adheres to patient rights: provides for the confidential treatment of all communications and records.
Professionalism - demonstrates professionalism with families, visitors, physicians, co-workers and supervisors.
Communication - listens and communicates effectively
Teamwork - supports teamwork by cooperative problem solving through participation in meetings, projects, etc.
Quality/ Performance Improvement - utilizes principles of continuous quality improvement in all work situations to assess, measure and improve organizational and department functions
Autonomy - organizes work sets priorities with a minimum of supervision and seeks guidance as appropriate
Accountability - makes decisions that are timely and consistent with department, objectives, policies and procedures.
Ownership - demonstrates sound judgment; accepts and benefits from constructive criticism
Analyzes and researches denials, follows-up with the payer to resolve denials
Reviews applicable timeframes governing the appeal process
Contacts appropriate third party for outcome of clinical appeal
Evaluates appeal outcome for next steps (logs recovered funds, supports uphold decision or initiates 2nd level appeal)
Documents accurately and timely the follow-up requirement on denials
Maximize utilization of Contract Management tools and efficient use of existing resources to support cash collection activities
Exercise judgment pertaining to highly sensitive and confidential information
Understanding of claims processing
Demonstrated ability to work independently and on a team as the situation demands.
Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.Duties, responsibilities and activities may change at any time with or without notice.
Benefits and Perks
Paid Time Off (PTO)
Medical and Prescription Drug Insurance
Dental and Vision Insurance
Retirement Plans
Short & Long Term Disability
Life & Accidental Death Insurance
Tuition Reimbursement
Health Care/Dependent Care Flexible Spending Accounts
Wellness Programs
Voluntary Benefits (e.g., Pet Insurance)
Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!
Choosing RWJBarnabas Health! RWJBarnabas Health is the premier health care destination providing patient-centered,high-quality academic medicine in a compassionate and equitable manner, while deliveringa best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.
RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey—whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.
Equal Opportunity Employer
#J-18808-Ljbffr
Location: System Business Office
Department Name: Appeals
Req #: 0000220243
Status: Salaried
Shift: Day
Pay Range: $62,476.00 - $88,248.00 per year
Pay Transparency The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.
The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.
Job Overview The DataAnalyst, Appeals is primarily responsible for validating clinical and technical denials to ensure appeals are accurately pursued. Daily work includes ordering medical records, entering denials, and calling payers to gather account information as well as appeal outcomes. In this role, you would be responsible for formulating and submitting the appeal for out-patient no authorization/ medical necessity denials.
Qualifications Required:
HS diploma or GED equivalent.
2+ years working for hospitals or payers in a similar capacity.
Proficient in medical terminology and knowledge of commercial insurance.
Microsoft Office
Microsoft Excel skills required.
Preferred:
Associate’s degree in business or finance preferred.
Scheduling Requirements
Full-Time, Salaried position– 40 hours a week
Travel to Oceanport, NJ as needed
MUST be located in NJ, NY, or PA
Essential Functions
Confidentiality - adheres to patient rights: provides for the confidential treatment of all communications and records.
Professionalism - demonstrates professionalism with families, visitors, physicians, co-workers and supervisors.
Communication - listens and communicates effectively
Teamwork - supports teamwork by cooperative problem solving through participation in meetings, projects, etc.
Quality/ Performance Improvement - utilizes principles of continuous quality improvement in all work situations to assess, measure and improve organizational and department functions
Autonomy - organizes work sets priorities with a minimum of supervision and seeks guidance as appropriate
Accountability - makes decisions that are timely and consistent with department, objectives, policies and procedures.
Ownership - demonstrates sound judgment; accepts and benefits from constructive criticism
Analyzes and researches denials, follows-up with the payer to resolve denials
Reviews applicable timeframes governing the appeal process
Contacts appropriate third party for outcome of clinical appeal
Evaluates appeal outcome for next steps (logs recovered funds, supports uphold decision or initiates 2nd level appeal)
Documents accurately and timely the follow-up requirement on denials
Maximize utilization of Contract Management tools and efficient use of existing resources to support cash collection activities
Exercise judgment pertaining to highly sensitive and confidential information
Understanding of claims processing
Demonstrated ability to work independently and on a team as the situation demands.
Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.Duties, responsibilities and activities may change at any time with or without notice.
Benefits and Perks
Paid Time Off (PTO)
Medical and Prescription Drug Insurance
Dental and Vision Insurance
Retirement Plans
Short & Long Term Disability
Life & Accidental Death Insurance
Tuition Reimbursement
Health Care/Dependent Care Flexible Spending Accounts
Wellness Programs
Voluntary Benefits (e.g., Pet Insurance)
Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!
Choosing RWJBarnabas Health! RWJBarnabas Health is the premier health care destination providing patient-centered,high-quality academic medicine in a compassionate and equitable manner, while deliveringa best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.
RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey—whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.
Equal Opportunity Employer
#J-18808-Ljbffr