Denials & Appeals RN - Revenue Cycle Expert

Atlantic Health System; Morristown (NJ); On-site; USD 90,000 - 130,000; Full time

Job summary

Atlantic Health System in Morristown, NJ seeks a Denials Management Nurse to lead clinical review of denied services and craft appeals to maximize reimbursement.

You will collaborate with revenue cycle leadership to improve denial workflows, root-cause analysis, and departmental reporting.

The role requires active NJ RN license, BSN preferred, 3–5+ years acute care, and expertise in utilization review, case management, and denials/appeals.

Qualifications

• Active NJ RN license is required.
• BSN preferred.
• 3-5+ years of clinical experience (acute care preferred).
• Experience in utilization review, case management, denials/appeals or revenue cycle.

Responsibilities

• Develop the denials department and create workflows for in-house submission of denials.
• Determine root cause of denials.
• Establish and manage relationships with AHS leaders and review denials information.
• Effectively manage the department's workflow processes to ensure timely submissions.
• Understand explanations of benefits from payors across non-governmental claims.
• Analyze hospital claims data to identify underpayments, denials, and errors.
• Make billing adjustments in system based on denial outcomes.
• Submit information to payors and follow up on in-house denials.
• Manage assigned work queues (Revenue integrity and denials).
• Provide monthly denial reports to department manager and stakeholders.
• Able to work independently.

Skills

Denials/Appeals

Revenue Cycle

Utilization Review

Case Management

Clinical Documentation Improvement

Medical Record Audits

Education

Active NJ Registered Nurse (RN) license

Bachelor of Science in Nursing (BSN) preferred

Job description

Atlantic Health System in Morristown, NJ seeks a Denials Management Nurse to lead clinical review of denied services and craft appeals to maximize reimbursement.

You will collaborate with revenue cycle leadership to improve denial workflows, root-cause analysis, and departmental reporting.

The role requires active NJ RN license, BSN preferred, 3–5+ years acute care, and expertise in utilization review, case management, and denials/appeals.