Supervisor, Appeals, Remote, NJ at RWJBarnabas Health – Oceanport, New Jersey

Job Overview:

The Supervisor is responsible for managing technical and clinical denials and works to resolve the denials and authorizations. They will collaborate with Case Management and Centralized Scheduling to ensure compliance pertaining to denial/appeal process with focus on obtaining optimal reimbursement.

The Supervisor is primarily responsible to ensure the staff is properly validating clinical and technical denials to ensure appeals are accurately pursued. In this role, you would be responsible for managing the process flow, and ongoing training.

Qualifications:

Required:

• Bachelor’s degree required in Finance, Healthcare or related field
• At least five years managed care appeal experience
• Focused denials and appeals management experience
• 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 Microsoft Office skills, particularly Microsoft Excel
• Ability to work well individually and in a team environment

Essential Functions:

• Demonstrates ability to critically think, problem solve and make independent decisions supporting workflow and appeal process.
• Maintain and Organize the workflow to ensure that denials are worked according to departmental policy and standards
• Create action plans, process improvement and address gaps and opportunities for improvement from front end to back end
• Maintain training documents
• Create a systematic reporting mechanism monthly that analyzes denials, identifying changes and/or trends, and reports these to management
• Identify all denial trends and provide education of steps to prevent future avoidable denials
• Research payer denials related to referral, pre-authorization and medical necessity
• Validate denial reasons and ensure denials reason is accurate and reflects 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 resolution
• Research contract terms/interpretation and compile necessary supporting documentation for appeals adjudication issues, and referral to refund unit on overpayments and recoupments
• Work payer projects as directed
• Develop and support effective working relationships among various departments for root cause analysis and resolutions
• Reviews accounts and makes recommendations to management regarding non collectible accounts

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.