Hudson Regional Health · 2 weeks ago
Clinical Appeal Denial Writer
Clifton, NJ, US
Full-time
Onsite
Entry, Mid Level
1+ years expHudson Regional Health is seeking a Clinical Appeal Denial Writer to manage and review clinical denial appeals. The role involves writing clinical appeals, auditing medical and billing records, and ensuring compliance with regulations while collaborating with healthcare professionals.
Health CareHospital
Responsibilities
Coordinates appeal for clinical denials to managed care/insurance companies and governmental agencies
Writes clinical appeals and audits patient medical and billing records to determine documentation and items billing are appropriate
Follows through to ensure that audit adjustments are made and corrective actions are taken to address identified billing, charging, and documentation issues
Prepares first, second, and third level appeals utilizing relevant clinical information and professional standards and guidelines
Collaborate with each hospital physician advisors and Utilization/Case Managers
Performs other duties as assigned
Possesses and consistently develops the ability to understand medical policies for commercial carriers to determine the medical necessity for audits
Remains current with all governmental regulations and policies related to audits including RAC and others. Maintains working knowledge of governmental regulations for billing purposes when performing audits
Proposes language changes because of denial reviews and observations
Obtains a thorough understanding of managed care contracts as part of appeal process
Collaborates with physicians and leadership to enhance denial management and improve clinical documentation improvement efforts
Qualification
Required
Manages and reviews clinical denial appeals to payers
Coordinates appeal for clinical denials to managed care/insurance companies and governmental agencies
Writes clinical appeals and audits patient medical and billing records to determine documentation and items billing are appropriate
Follows through to ensure that audit adjustments are made and corrective actions are taken to address identified billing, charging, and documentation issues
Prepares first, second, and third level appeals utilizing relevant clinical information and professional standards and guidelines
Collaborate with each hospital physician advisors and Utilization/Case Managers
Performs other duties as assigned
Possesses and consistently develops the ability to understand medical policies for commercial carriers to determine the medical necessity for audits
Remains current with all governmental regulations and policies related to audits including RAC and others
Maintains working knowledge of governmental regulations for billing purposes when performing audits
Proposes language changes because of denial reviews and observations
Obtains a thorough understanding of managed care contracts as part of appeal process
Collaborates with physicians and leadership to enhance denial management and improve clinical documentation improvement efforts
Clinical knowledge to denial appeals process
Knowledge of regulatory and payer requirements for reimbursement and reasons for denials by auditors
Outstanding organization skills
Excellent verbal and written communication skills
Proficient in Microsoft Office
The ability to quickly gain comfort with other software programs needed to perform the essential functions of the position
Thorough understanding of clinical processes and knowledge of billing, coding and Milliman Care Guideline (MCG) criteria
Active RN license in the state of NJ
Minimum of 1 year Clinical Medical Necessity Appeals preparation
Preferred
Three years of experience in acute care utilization review is preferred
BSN preferred
Company
Hudson Regional Health
Hudson County’s largest healthcare system, New Jersey’s fourth-largest, and the fastest-growing in the state.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Nizar Kifaieh, MD, MBA, CPE, FACEP
President and CEO
Harry Kapralos
Vice President & Chief Legal Officer
Recent News
Fierce Healthcare
2025-06-06
Fierce Healthcare
2025-05-10
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