Denials & Appeals Specialist — Optimize Reimbursements

Stony Brook University; Stony Brook (NY); On-site; USD 89,760 - 127,975; Full time

Job summary

Stony Brook University is seeking a Denials and Appeals Case Manager to perform quality retrospective chart reviews for potential appeals of denied days across government and external payers. You will track denial activity, collaborate with financial services, and present findings to improve reimbursement and patient care.

Responsibilities include conducting utilization reviews, collecting data on denial patterns, educating staff, and supporting a multidisciplinary team in complex cases while

Qualifications

• RN Licensure NY State.
• Bachelor's Degree or enrollment.
• Five years’ experience in Acute Care Hospital.
• Good writing skills and computer efficiency.
• Experience in Case Management, Quality, or Utilization Management.
• Working knowledge of MCG and/or InterQual.
• Excellent communication and interpersonal skills.
• High level of customer service.
• Creativity, flexibility, professional and courteous.
• Weekday and weekend flexibility.
• Ability to work independently.

Responsibilities

• Provide Utilization Reviews for Short Stay and Observation.
• Conduct retrospective review for potential appeal of all denied cases.
• Participate proactively and collaborate to enhance reimbursements and reduce denials.
• Collect and maintain data to identify patterns, trends, and solutions with reports on all denial activity.
• Document avoidable delays and admissions.
• Promote continuous quality improvement and efficient use of hospital resources.
• Collaborate with the interdisciplinary team on all complex cases; maintain high level of customer service.
• Review retrospective denials for managed care, Medicare, and Medicaid.
• Present and educate staff on denials.

Skills

Writing skills

Communication skills

Interpersonal skills

Customer service

Education

RN Licensure NY State

Bachelor's Degree or enrollment

Tools

Word

Excel

Access

Job description

Stony Brook University is seeking a Denials and Appeals Case Manager to perform quality retrospective chart reviews for potential appeals of denied days across government and external payers. You will track denial activity, collaborate with financial services, and present findings to improve reimbursement and patient care.

Responsibilities include conducting utilization reviews, collecting data on denial patterns, educating staff, and supporting a multidisciplinary team in complex cases while