Inpatient Clinical Denial Specialist - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ

Responsibilities

• Reviews and triages inpatient clinical denials, including medical necessity, patient status, and readmission-related denials.
• Routes cases to appropriate clinical resources (Clinical Appeals RN, CDI, UR/Case Management, Physician Advisor) based on denial type and appeal viability.
• Maintains accurate inpatient clinical denial inventories, including deadlines, appeal levels, documentation status, and outcomes.
• Captures medical record requests, appeal packet preparation logistics, and submission tracking.
• Coordinates payer follow-up activities, including portal research and telephone outreach as needed.
• Documents clear, concise, and accurate notes in the hospital billing system related to denial actions and status.
• Identifies recurring inpatient clinical denial trends by payer, service line, unit, or provider and escalates findings to leadership.
• Supports denial prevention initiatives by partnering with Utilization Review, Case Management, CDI, and clinical leadership.
• Maintains current knowledge of payer inpatient denial practices and appeal processes.
• Performs other duties as assigned and adapts to changing departmental demands.

Requirements

• Education: High school diploma or equivalent required. Associate or bachelor’s degree in healthcare or business-related field preferred.
• Experience: Three years' hospital billing, denials management, utilization review support, or related revenue cycle experience. Experience working inpatient clinical denials, patient status determinations, or medical necessity denials strongly preferred.

Qualifications

• Working knowledge of inpatient clinical denial categories, including medical necessity, patient status, and readmissions.
• Familiarity with utilization review processes and clinical documentation workflows.
• Strong organizational skills and attention to detail.
• Ability to identify root causes and recurring denial drivers.
• Strong written communication skills for documentation and internal coordination.
• Proficiency with hospital billing systems, EMR navigation, and payer portals.
• Proficiency with Microsoft Office applications, including Excel.

Skills

• Ability to perform detailed tracking, documentation, and inventory management across multiple appeal levels.
• Ability to meet deadlines and attention to detail.
• Good judgment.
• Metric-driven and results oriented.

Benefits

• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA)
• Healthcare FSA
• Dependent Care FSA
• Retail 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 Life
• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program