Denials Representative -Full-Time

About the Role

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. The Denials Representative investigates, appeals, and resolves denied or underpaid insurance claims to maximize reimbursement, collaborating with internal departments and insurance payers to identify denial trends and support process improvements that strengthen the hospital's revenue cycle.

Responsibilities

• 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

Requirements

• 1–3 years of hospital billing and denials experience required
• Coding experience preferred

Qualifications

• Bachelor’s Degree preferred

Skills

• 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 process improvement

Benefits

Full-time and part-time employees have access to a comprehensive benefits package designed to support health, financial security, and quality of life, including:

• Low-cost medical coverage with generous employer contributions
• Dental and vision plans
• Discounted prescriptions
• Access to on-site child care
• 401(k) matching
• Tuition reimbursement
• Paid time off
• Flexible spending accounts
• Legal and voluntary coverage options
• Life insurance
• Free on-site parking

Pay

Pay range: $22.00/hour - $25.30/hour. Final base compensation will be determined based on factors such as employment status (Full/Part-Time or Per Diem), skills, education, and experience, with consideration for internal equity.