Denials Representative

Description

Denials Representative

Welcome to Holy Name, a medical center where innovation is not just a goal — it's a commitment. Here, medical excellence thrives, allowing hope to reign supreme and leaving no room for fear. At our hospital, every patient is cared for with undivided attention — because healing every soul is our sole focus.

Holy Name is New Jersey's only independent Catholic health system, comprising a 361-bed acute care hospital, a renowned cancer center, a state-of-the-art fitness center, a residential hospice, a prestigious nursing school, and an extensive physician network. Healing at Holy Name goes beyond medicine and technology – it is infused with faith, conviction, compassion, and a commitment to educating the next generation of healthcare professionals through a variety of residency and educational programs.

Our mission to provide care for the body, mind, and soul spans education, prevention, diagnosis, treatment, rehabilitation, and overall wellness. This is at the core of who we are and what we do, and we've done it this way across generations, every single day, for nearly 100 years. Every innovation, medical breakthrough, and groundbreaking treatment is powered by some of the best minds in medicine, ensuring nothing is left on the table or the road to recovery.

The Denials Representative is responsible for investigating, appealing, and resolving denied or underpaid insurance claims to maximize reimbursement. This position collaborates with internal departments and insurance payers to resolve claim issues, identify denial trends, and support process improvements that strengthen the hospital's revenue cycle.

• 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

• Bachelor’s Degree Preferred

• 1
  -3 Years Hospital billing and Denials experience required
• Coding experience preferred

• Strong analytical, problem-solving, and critical thinking skills
• Excellent attention to detail, organization, and time management
• Working knowledge of Medicare, Medicaid, managed care, and commercial insurance reimbursement
• Familiarity with medical terminology and coding concepts, including ICD-10-CM, CPT, and HCPCS
• Ability to interpret EOBs, remittance advice, payer policies, and reimbursement guidelines
• Experience with electronic health records (EHRs), patient accounting systems, and payer portals
• Effective verbal and written communication skills with the ability to collaborate across departments and with insurance representatives
• Ability to manage multiple priorities, work independently, and meet deadlines in a fast-paced environment
• Commitment to professionalism, customer service, confidentiality, and continuous…