Denial Process Rep - FT - Day - Hospital Billing Lawrenceville NJ

Denial Process Representative Analyzes all patient accounts denied of correct payment by Managed Care Payors and works with proper departments to ensure payments and collections of money owed to Capital Health (CH).Education: High school diploma or equivalent.Experience: One year related experience.Essential Functions:Instructs and assists co-workers to identify and organize data relating to incorrect payments or denials for reconciliation and appeals.Frequently receives, provides, clarifies or exchanges information with Managers/Directors within department. Has frequent interaction with Case Management, Quality Resource Management, Patient Access, and Patient Accounts.Coordinates and attends denial work sessions with other hospital departments directly involved with denials process.Utilizes Denial Management software to monitor and review monthly trends prior to report distribution.Downloads and manipulates excel spreadsheets from Denial Management software to be distributed to various CH departments in order to identify denial patterns, trends, and issues.Analyzes data obtained from Denial Management software and shares information with Director and staff.Identifies trends for improvement in order to increase percentage of first pass clean claim submission.Responsible for providing weekly report of claims referred to outsource denial management vendor.Requests reports in HBOC and Aergo to gather information for purpose of identifying payment problems and trends.Physical Demands and Work Environment:Frequent physical demands include: Sitting. Occasional physical demands include: Standing, Walking, Climbing (e.g., stairs or ladders), Carry objects, Push/Pull, Twisting, Bending, Reaching forward, Reaching overhead, Squat/kneel/crawl, Wrist position deviation, Pinching/fine motor activities, Keyboard use/repetitive motion. Continuous physical demands include: Lifting Floor to Waist 20 lbs. Lifting Waist Level and Above 10 lbs. Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing.Anticipated Occupational Exposure Risks Include the following: N/AThis position is eligible for the following benefits:Medical PlanPrescription drug coverage & In-House Employee PharmacyDental PlanVision PlanFlexible Spending Account (FSA)Retirement Savings and Investment PlanBasic Group Term Life and Accidental Death & Dismemberment (AD&D) InsuranceSupplemental Group Term Life & Accidental Death & Dismemberment InsuranceDisability Benefits Long Term Disability (LTD)Disability Benefits Short Term Disability (STD)Employee Assistance ProgramCommuter TransitCommuter ParkingSupplemental Life InsuranceVoluntary Life SpouseVoluntary Life EmployeeVoluntary Life ChildVoluntary Legal ServicesVoluntary Accident, Critical Illness and Hospital Indemnity InsuranceVoluntary Identity Theft InsuranceVoluntary Pet InsurancePaid Time-Off ProgramThe pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.