Outpatient Denials & Appeals Coordinator

Capital Health Screening Centre; Princeton (NJ); On-site; USD 28,000 - 36,000; Full time

Benefits offered by this job

Medical Plan

Dental Plan

Vision Plan

Flexible Spending Account

Retirement Plan

Life Insurance

Disability Benefits

Paid Time-Off

Job summary

Capital Health in New Jersey is seeking an experienced Denials Management Administrator. This role focuses on administrative management, tracking, and coordination of outpatient clinical denials, ensuring proper triage, routing, documentation, tracking, and appeal preparation in line with payer requirements.

It requires collaboration with clinical and operational resources to support timely resolution and denial prevention.

Qualifications

• Education: High school diploma or equivalent required; associate or bachelor’s degree preferred.
• Three years' hospital billing, denials management, utilization review support, or related revenue cycle experience.
• Experience with outpatient clinical denials or medical necessity line-item denials strongly preferred.

Responsibilities

• Reviews and triages outpatient clinical denials, including medical policy, experimental/investigational, and clinical criteria denials.
• Routes cases to appropriate clinical resources based on denial type and appeal viability.
• Maintains accurate outpatient clinical denial inventories, including deadlines, appeal levels, documentation status, and outcomes.
• Coordinates medical record requests, appeal packet preparation logistics, and submission tracking.
• Ensures compliance with payer requirements, timelines, and documentation standards for outpatient clinical denials.
• Performs payer follow-up activities, including portal research and telephone outreach as needed.
• Documents clear, concise, and accurate notes in the hospital billing system related to denial actions and status.
• Identifies recurring denial trends by payer, policy, procedure, or department and escalates findings to leadership.
• Supports denial prevention initiatives by partnering with ordering providers, authorization teams, Revenue Integrity, and operational leaders.
• Maintains current knowledge of payer outpatient medical policies and appeal processes.
• Performs other duties as assigned and adapts to changing departmental demands.

Skills

Outpatient denial knowledge

Payer authorization processes

Documentation workflows

Root cause analysis

Written communication

Hospital billing systems

EMR navigation

Payer portals

Organizational skills

Education

High school diploma

Associate or bachelor’s degree in healthcare or business

Job description

Capital Health in New Jersey is seeking an experienced Denials Management Administrator. This role focuses on administrative management, tracking, and coordination of outpatient clinical denials, ensuring proper triage, routing, documentation, tracking, and appeal preparation in line with payer requirements.

It requires collaboration with clinical and operational resources to support timely resolution and denial prevention.