Section II: Summary of Job Function
This Associate Analyst, Appeals is primarily responsible for validating clinical and technical denials to ensure appeals are accurately pursued. Daily work includes ordering medical records, entering denials, and calling payers to gather account information as well as appeal outcomes.
Section II: Position Responsibilities
Analyzes and researches denials, follows-up with the payer to resolve denials
- Reviews applicable timeframes governing the appeal process
- Contacts appropriate third party for outcome of clinical appeal
- Evaluates appeal outcome for next steps (logs recovered funds, supports uphold decision or initiates 2nd level appeal)
- Documents accurately and timely the follow-up requirement on denials
- Maximize utilization of Contract Management tools and efficient use of existing resources to support cash collection activities
- Exercise judgment pertaining to highly sensitive and confidential information
- Understanding of claims processing
Demonstrated ability to work independently and on a team as the situation demands
Section III: Education/Experience
Associate s degree in business or finance preferred
Proficient in medical terminology and knowledge of commercial insurance
Average Microsoft Excel skills required
Section IV: Special Equipment/Skills
Confidentiality - adheres to patient rights: provides for the confidential treatment of all communications and records.
- Professionalism - demonstrates professionalism with families, visitors, physicians, co-workers and supervisors.
- Communication - listens and communicates effectively
- Teamwork - supports teamwork by cooperative problem solving through participation in meetings, projects, etc.
- Quality/ Performance Improvement - utilizes principles of continuous quality improvement in all work situations to assess, measure and improve organizational and department functions
- Autonomy - organizes work sets priorities with a minimum of supervision and seeks guidance as appropriate
- Accountability - makes decisions that are timely and consistent with department, objectives, policies and procedures.
- Ownership - demonstrates sound judgment; accepts and benefits from constructive criticism
We offer a great work environment, competitive rates and excellent benefits, including:
Vacation/Personal/Holiday/Sick Time Off
Short & Long Term Disability
Basic Life & Accidental Death Insurance
Health Care/Dependent Care Flexible Spending Accounts
RWJBarnabas Health is the most comprehensive health care delivery system in New Jersey and the state s second largest private employer with more than 32,000 employees, 9,000 physicians and 1,000 residents and interns. The system includes eleven acute care hospitals, three acute care children s hospitals and a leading pediatric rehabilitation hospital (Children s Specialized Hospital).