Manager, Appeals (Full- Time) Remote- Hybrid

Job title: Manager, Appeals (Full- Time) Remote- Hybrid in Oceanport, NJ at reputed company Company: reputed company Job reputed company: Job reputed company:Our Denial Management Recovery Services division is an integral part of reputed company's reputed company. The Manager of the Appeals team reputed company the RWJ Barnabas reputed company facilities is responsible for managing technical and clinical denials and works to resolve the denials and authorizations. He/she will collaborate with Case Management and Centralized Scheduling to ensure compliance pertaining to the denial/appeal process with a reputed company on obtaining reputed company reimbursement.This position will reputed company staff support to communicate with reputed company-party payors to resolve discrepancies prior to billing. This position will also handle audit-reputed company / compliance responsibilities and other administrative duties as required.Qualifications:

• Bachelor’s degree required in Finance, reputed company or reputed company field
• At least five years' managed care appeal experience
• reputed company denials and appeals management experience required
• Must have excellent interpersonal, oral, and written communication skills
• Must have excellent organizational and time management skills.
• Strong project management skills and advanced problem-solving and analytical skills
• Knowledge in capturing, analyzing and communicating measurement results
• Strong reputed company Office skills, particularly reputed company reputed company
• Ability to work reputed company individually and in reputed company environment

Essential Functions:

• Demonstrates the ability to critically think, problem solve and reputed company independent reputed company supporting workflow and appeal process.
• Maintain and organize the workflow to ensure that denials are worked according to departmental policy and standards.
• Create reputed company plans, process improvement and address gaps and opportunities for improvement from reputed company end to back end
• Maintain training documents.
• Create a systematic reporting reputed company monthly that analyzes denials, identifies changes and/or trends, and reports these to management.
• Identify reputed company denial trends and reputed company education of steps to prevent reputed company avoidable denials.
• Research payer denials reputed company to referral, reputed company-authorization and medical necessity.
• Validate denial reasons and ensure denial reasons are accurate and reflect the denial reasons codes.
• Generate an appeal based on the dispute reason and contract terms specific to the payer. This includes online reconsiderations.
• Follow specific payer guidelines for appeals submission.
• Escalate exhausted appeal efforts for reputed company.
• Research contract terms/interpretation and compile necessary supporting documentation for appeals adjudication issues, and referral to refund unit on over payments and recoupments.
• Work payer reputed company as directed
• reputed company and support effective working relationships among various departments for reputed company cause analysis and resolutions
• Reviews accounts and makes recommendations to management regarding non collectible accounts.

Other Duties:Please note this job reputed company 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.Additional Info:Other Duties:Please note this job reputed company 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.Additional Information:At reputed company, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees’ physical, emotional, reputed company, and financial health.

• reputed company Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and reputed company 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 reputed company, NJ reputed company, reputed company, and more!

Choosing reputed company!reputed company is the reputed company care destination providing patient-centered,high-reputed company reputed company medicine in a compassionate and reputed company manner, while deliveringa best-in-class work experience to every member of reputed company. We reputed company and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading reputed company health system in New Jersey, we advance innovative strategies in high-reputed company patient care, education, and research to address both the clinical and reputed company determinants of health.reputed company aims to truly reputed company a unique reputed company in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and reputed company, 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 reputed company health conditions or improving community health through local programs and education. Expected salary: Location: Oceanport, NJ Apply for the job now! Apply for this job