DENIAL MANAGEMENT ANALYST

Montefiore Health System; New Jersey; On-site; USD 49,920 - 62,400; Full time

Job summary

A prestigious healthcare institution in New Jersey seeks a denial management specialist to research, analyze, and process appeals for denials. The ideal candidate has 3-5 years experience in appeals, strong EPIC and Excel skills, and a CPC certification. This role involves identifying root causes and maximizing revenue through effective communication and analytical skills, ensuring quality care for patients with developmental disabilities. Competitive pay based on experience.

Qualifications

• Three to five years of progressive experience in appeal/denial management is preferred.
• Strong knowledge of health plan requirements is essential.
• Ability to work effectively in a fast-paced clinic environment.

Responsibilities

• Research and analyze denials on a daily basis.
• Identify root causes and process resubmissions/appeals.
• Aim to overturn denials and maximize revenue.

Skills

Analytical skills

Statistical analysis

Organizational skills

Communication skills

Epic knowledge

Microsoft Excel

Knowledge of CPT coding

Knowledge of ICD10 diagnosis

Education

Bachelor's Degree preferred

Certified Professional Coder (CPC)

Associate's Degree required

Tools

EPIC

Microsoft Word

Microsoft PowerPoint

Job description

Job Details

• City/State: Bronx, New York
• Grant Funded: No
• Department: NoMgr
• Work Shift: Day
• Work Days: MON-FRI
• Scheduled Hours: 8:30 AM-5 PM
• Scheduled Daily Hours: 7.5 HOURS
• Pay Range: $49,920.00-$62,400.00

Responsibilities

Researches and analyzes denials on a daily basis, identifies root causes, and processes resubmissions/appeals with the goal of overturning the denial and getting paid by the insurance carrier, maximizing revenue for the division.

Qualifications

• Three to five years of progressive experience in appeal/denial management - Preferred
• Strong knowledge of health plan requirements
• Strong analytical, statistical analysis skills required
• Strong knowledge of EPIC, Microsoft Excel, Word and Power Point skills required
• Knowledge of federal, regional and state payer coverage patterns (CMS, fiscal intermediary, and Administrative)
• Strong organizational and communication skills; professionalism, able to work with all levels of staff.
• Bachelor's Degree preferred (Certified Professional Coder (CPC); Associate's Degree required (Medical Billing experience)).
• Certified Professional Coder (CPC) required
• EPIC Cadence, HB, PB certifications preferred
• Knowledge of CPT coding and ICD10 diagnosis required
• Ability to work and effectively multi-task in a fast-paced clinic environment with patients with developmental disabilities.

Montefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.