Denials & Appeals Specialist - Revenue Cycle

Holy Name Medical Center; Hackensack (NJ); On-site; USD 63,039,000 - 72,495,000; Full time

Benefits offered by this job

Low-cost medical coverage

Dental and vision plans

Discounted prescriptions

On-site child care

401(k) matching

Tuition reimbursement

Paid time off

Flexible spending accounts

Legal coverage options

Life insurance

Free on-site parking

Job summary

Holy Name Medical Center in Hackensack, NJ, seeks a Denials Representative to investigate, appeal, and resolve denied or underpaid claims to maximize reimbursement. You will review patient accounts, use medical records and payer guidelines, and prepare timely appeals across payer types.

Responsibilities include collaborating with coding, patient access, utilization management, and billing teams; documenting activity; monitoring denial inventory; and staying current on reimbursement rules.

Qualifications

• 1–3 years of hospital billing and denials experience.
• Coding experience preferred.
• Familiarity with Medicare/Medicaid and commercial insurance reimbursement.
• Ability to interpret EOBs and remittance advice.
• Strong analytical and problem-solving abilities.

Responsibilities

• Review and investigate denied and underpaid insurance claims to determine the cause of non-payment
• Research patient accounts using medical records, coding, documentation, authorizations, and payer guidelines
• Prepare, submit, and monitor appeals in accordance with payer requirements and filing deadlines
• Communicate with insurance companies to resolve claim issues and secure appropriate reimbursement
• Collaborate with coding, patient access, utilization management, case management, and billing teams to resolve denials
• Document account activity and maintain accurate records within the patient accounting system
• Monitor assigned denial inventory and ensure timely follow-up through final resolution
• Identify denial trends and recommend process improvements to reduce future denials
• Maintain current knowledge of payer policies, billing regulations, and reimbursement guidelines
• Assist with audits, quality improvement initiatives, and other revenue cycle projects
• Comply with HIPAA, hospital policies, and all applicable federal and state regulations

Skills

Analytical skills

Attention to detail

Time management

Communication skills

Medicare knowledge

ICD-10-CM coding

EHRs experience

Education

Bachelor’s Degree Preferred

Job description

Holy Name Medical Center in Hackensack, NJ, seeks a Denials Representative to investigate, appeal, and resolve denied or underpaid claims to maximize reimbursement. You will review patient accounts, use medical records and payer guidelines, and prepare timely appeals across payer types.

Responsibilities include collaborating with coding, patient access, utilization management, and billing teams; documenting activity; monitoring denial inventory; and staying current on reimbursement rules.