Denials Specialist - Hospital Revenue Cycle

Holy Name Medical Center; Hackensack (NJ); On-site; USD 30,000 - 34,000; Full time

Benefits offered by this job

Medical coverage

Dental and vision plans

401(k) matching

Tuition reimbursement

Paid time off

Job summary

Holy Name Medical Center in Hackensack, NJ is seeking a Denials Representative to investigate, appeal, and resolve denied or underpaid insurance claims to maximize reimbursement. You will work with coding, patient access, utilization management, case management, and billing teams to resolve issues and improve processes.

The role requires 1–3 years of hospital billing and denials experience with knowledge of payer policies, ICD-10-CM, CPT, and HCPCS. A Bachelor’s Degree is preferred.

Qualifications

• Bachelor’s Degree preferred for the role.
• 1–3 years hospital billing and denials experience required.
• Coding experience is preferred.
• Strong analytical, problem-solving, and attention to detail.
• Working knowledge of Medicare, Medicaid, and payer guidelines.
• Familiarity with ICD-10-CM, CPT, HCPCS concepts.

Responsibilities

• Review and investigate denied and underpaid insurance claims to determine non-payment causes.
• Research patient accounts using medical records, coding, documentation, authorizations, and payer guidelines.
• Prepare, submit, and monitor appeals in accordance with payer requirements and deadlines.
• Communicate with insurance companies to resolve claim issues and obtain reimbursement.
• Collaborate with coding, patient access, utilization management, case management, and billing teams to resolve denials.
• Document account activity and maintain accurate records in the patient accounting system.
• Monitor denial inventory and ensure timely follow-up through final resolution.
• Identify denial trends and suggest process improvements to reduce future denials.
• Stay updated on payer policies, billing regulations, and reimbursement guidelines.
• Assist with audits, quality improvement initiatives, and revenue cycle projects.
• Ensure compliance with HIPAA and hospital policies.

Skills

Analytical skills

Attention to detail

Medicare/Medicaid knowledge

Medical terminology & coding concepts

EOB interpretation

EHRs and billing systems

Communication skills

Multitasking

Professionalism

Education

Bachelor's Degree Preferred

Job description

Holy Name Medical Center in Hackensack, NJ is seeking a Denials Representative to investigate, appeal, and resolve denied or underpaid insurance claims to maximize reimbursement. You will work with coding, patient access, utilization management, case management, and billing teams to resolve issues and improve processes.

The role requires 1–3 years of hospital billing and denials experience with knowledge of payer policies, ICD-10-CM, CPT, and HCPCS. A Bachelor’s Degree is preferred.