Denials & Appeals Manager - SBH Health System : Job Details

The Denials & Appeals Manager will be r esponsible for r eviewing physician's clinical documentation to appeal, and identify denial trends based on medical necessity, underpayments and present resolution with the goal of clinical denial reduction. This role will identify denials trends based on medical necessity, underpayments and presenting resolutions with the goal of denials reduction. Review adverse determinations and claims to assist in the identification of denials and timely appeal referral with the goals of procuring reimbursement as well identifying denial root cause.

Primary Responsibilities:

• Reporting: Denials – assists with preparing reports as needed (daily/weekly/monthly)
• Reports of weekly denials submitted for agency appeal
• Utilized ACM and monthly agency data for denials and appeals reports as requested by department heads and various committees.
• Denials and Approvals Correspondence:
• Review payer correspondences including adverse determination letters, payer “End of Day Reports (EDOR), authorization and appeal response letters received via mail or scanned by Case Management.
• Utilize ACM and Case Management peer-to-peer log for most updated documented authorization status.
• Review claims to identify clinical, technical denials
• Ensure timely appeal referral with the goals of procuring reimbursement

Requirements

• Bachelor's Degree required
• Preferred clinical experience in a hospital/healthcare setting

Union Position

Non-Union

Regular or Temporary

Regular

Salary Type (FLSA)

Exempt

Salary Range

95,000

Position Type

Full-time

Position Number

IL055202

Home DepartmentShiftAbout the company

St Barnabas Hospital is a non-profit hospital founded in 1866.

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