Manager Clinical Denials - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ

Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. The Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Position Overview Performs a variety of IP denials management activities to promote quality, clinical and cost‑effective outcomes.

Manages activities of assigned staff in the process of denials management and denials monitoring. Plans, assigns, reviews, and evaluates work delegated to staff. Monitors, reviews and assists to resolve denied claims.

Follows denials process lifecycle until resolved to assure timeliness of response and identify appeal opportunities. Salary and Benefits Pay Range: $94,140.80 – $122,990.40 Scheduled Weekly Hours: 40 Full‑time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part‑time).

Benefits include: Medical Plan Prescription drug coverage & In‑House Employee Pharmacy Dental Plan Vision Plan Flexible Spending Account (FSA) Healthcare FSA Dependent Care FSA Retirement Savings and Investment Plan Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance Supplemental Group Term Life & Accidental Death & Dismemberment Insurance Disability Benefits – Long Term Disability (LTD) Disability Benefits – Short Term Disability (STD) Employee Assistance Program Commuter Transit Commuter Parking Supplemental Life Insurance Voluntary Life Spouse Voluntary Life Employee Voluntary Life Child Voluntary Legal Services Voluntary Accident, Critical Illness and Hospital Indemnity Insurance Voluntary Identity Theft Insurance Voluntary Pet Insurance Paid Time‑Off Program Minimum Requirements Education: High school diploma or equivalent; Associate degree preferred. Experience: Five years’ experience in denials management, appeals, and payors. Other Credentials: Excellent interpersonal, communication and negotiation skills with ability to convey understanding of complex issues.

Strong organizational and time management skills. Strong leadership, motivational and team building skills. Analytical and data management skills.

Knowledge of insurance and government payer guidelines. Proficient with Microsoft Word and Excel, and Outlook. Familiarity utilizing electronic medical record, utilization management software, and other patient information software.

Essential Functions Performs daily denials management functions, including communication with payers, utilization staff, revenue cycle, patient access and HIM. Oversees IP denials management staff to ensure appropriate processes are followed according to Capital Health policy. Assesses educational needs and provides department specific training and ongoing mentoring to denials management staff.

Assures appropriate staffing levels, ongoing educational opportunities, employee satisfaction and customer satisfaction to maintain operational commitment. Conducts performance appraisals, manages reward and discipline process, addresses complaints, and resolves problems within the utilization review department. Maintains and organizes workflow to ensure denials are worked according to department policy and standards.

Monitors turnaround times to ensure staff performance and tracks improvements towards department goals. Identifies concurrent and retrospective denial prevention opportunities. Identifies denial trends and provides recommendations to prevent or reduce avoidable denials.

Ensures timely, accurate and efficient appeals for all medical necessity denials. Collaborates with leaders across the UR team to effectively problem solve and develop solutions to support department goals. Communicates with commercial and government payers to ensure IP reimbursement.

Maintains and enhances relationships with internal and external customers. Identifies opportunities and takes a leadership role in departmental performance improvement activities. Assures established outcome measures are met, and continuous quality improvement approach is in place for all denials management staff.

Performs other duties as assigned. Physical Demands and Work Environment Frequent physical demands include: Sitting, Standing, Walking, Carry objects, Wrist position deviation, Pinching/fine motor activities, Keyboard use/repetitive motion. Occasional physical demands include: Climbing (e.g., stairs or ladders), Push/Pull, Twisting, Bending, Reaching forward, Reaching overhead, Squat/kneel/crawl.

Continuous physical demands: Lifting Floor to Waist 15 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: Bloodborne Pathogens, Airborne Communicable Disease, Extreme Temperatures.

Additional Compensation Notes 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. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria. #J-18808-Ljbffr