Appeals Analyst, Fulltime, Remote, NJ at RWJBarnabas Health – Oceanport, New Jersey

Summary of Job Function

The Data Analyst, 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.

Education/Experience

• Associate’s degree in business or finance preferred
• 2+ years working for hospitals or payers in a similar capacity
• Proficient in medical terminology and knowledge of commercial insurance
• Average Microsoft Excel skills required

Special Equipment/Skills

• Microsoft Excel
• Microsoft Office
• Medical Terminology
• 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

Position Responsibilities

• 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