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

Position Overview

Responsible for administrative management, tracking, and coordination of outpatient clinical denials, including medical policy denials, experimental or investigational determinations, and other payer clinical criteria denials. Ensures outpatient clinical denial cases are properly triaged, routed, documented, tracked, and prepared for appeal in accordance with payer requirements, while partnering with clinical and operational resources to support timely resolution and denial prevention.

Minimum 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 outpatient clinical denials, or medical necessity line-item denials strongly preferred.

Other Credentials

• Working knowledge of outpatient clinical denial categories, including payer medical policy, experimental/investigational, and clinical criteria denials
• Familiarity with payer authorization processes and outpatient clinical documentation workflows
• Ability to perform detailed tracking, documentation, and inventory management across multiple appeal levels
• Strong organizational skills and attention to detail
• Ability to identify root causes and recurring outpatient denial drivers
• Strong written communication skills for documentation and internal coordination
• Proficiency with hospital billing systems, EMR navigation, and payer portals

Special Training

• Mental, Behavioral and Emotional Abilities: Must have ability to meet deadlines and attention to detail. Must demonstrate good judgment. Must be metric-driven and results oriented.

Physical Demands and Work Environment

• Frequent Physical Demands Include Occasional physical demands include: Continuous Physical Demands Include Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.
• Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Depth Perception, Accurate Hearing
• Anticipated Occupational Exposure Risks Include the following: N/A

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