Hospital Appeals Specialist (RN), Full Time, Days,8a-4p, PFS - Revenue Cycl at Atlantic Health

Morristown, New Jersey, United States -

Full Time

Start Date

Immediate

Expiry Date

08 Sep, 26

Salary

0.0

Posted On

10 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Denial Review, Medical Necessity Analysis, Appeal Letter Writing, Clinical Judgment, Physician Collaboration, Medical Record Audit, Revenue Cycle Management, Epic, Utilization Review, Case Management, Clinical Documentation Improvement, Regulatory Compliance, CMS Regulations, MCG Guidelines, InterQual Criteria, Data Tracking

Industry

Hospitals and Health Care

Description

Denial Review & Analysis • Review payer denials (medical necessity, level of care, authorization, DRG downgrades) • Analyze medical records against criteria such as MCG Guidelines and InterQual Criteria • Identify root causes (e.g., missing documentation, auth issues, late UR submission) Appeal Development • Write strong, evidence-based appeal letters using clinical judgment • Clearly articulate why inpatient/observation/services were appropriate • Write appeal letters for No Auth denials using the reason for failure to obtain appropriate authorization • Reference payer policies, CMS and NJ State regulations, and evidence-based guidelines • Prepare first-level, second-level, and external appeals Physician Collaboration • Partner with physician advisors for complex or high-dollar denials • Assist with Peer-to-Peer preparation and support • Translate clinical documentation into defensible arguments Documentation Review • Evaluate completeness and accuracy of medical records • Identify gaps impacting reimbursement (e.g., severity, risk, intensity of service) • Recommend documentation improvements to providers and CDI teams Regulatory & Payer Compliance: Stay current with: • Centers for Medicare & Medicaid Services rules • Commercial payer policies • Ensure appeals meet timely filing and submission requirements Data Tracking & Reporting • Track appeal outcomes and overturn rates • Identify denial trends and escalate systemic issues • Support denial prevention initiatives with actionable insights At Atlantic Health, our promise to our communities is; Anyone who enters one of our facilities will receive the highest quality care delivered at the right time, at the right place, and at the right cost. This commitment is also echoed in the respect, development and opportunities we give to our more than 22,000 team members. Headquarters in Morristown, New Jersey, we are one of the leading non-profit health care systems in the nation. Our facilities and sites of care include: * Atlantic Health Morristown Medical Center, Morristown, NJ * Atlantic Health Overlook Medical Center, Summit, NJ * Atlantic Health Newton Medical Center, Newton, NJ * Atlantic Health Chilton Medical Center, Pompton Plains, NJ * Atlantic Health Hackettstown Medical Center, Hackettstown, NJ * Atlantic Health Goryeb Children's Hospital, Morristown, NJ * Atlantic Health CentraState Healthcare System, Freehold, NJ * Atlantic Medical Group * Atlantic Visiting Nurse * Atlantic Mobile Health * Atlantic Rehabilitation We have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group. We have received awards and recognition for the services we have provided to our patients, team members and communities. Below are just a few of our accolades: * Chosen for 17 years by Fortune as one of the magazine’s “100 Best Companies to Work For." * Atlantic Health Morristown and Atlantic Health Overlook Named by Newsweek as two of the “World’s Best Hospitals” in 2026. * Atlantic Health Morristown and Atlantic Health Overlook ranked within the top three hospitals in New Jersey by U.S. News & World Report’s 2025-2026 Best Hospital rankings. * Atlantic Health scored four “A” grades by The Leapfrog Group in its Fall 2025 Hospital Safety Grades, performance measures reflecting errors, accidents, injuries and injections, as well as systems hospitals have in place to prevent harm. * Atlantic Health Morristown and Atlantic Health Overlook are New Jersey's only hospitals to be named among America's 50 Best hospitals by Healthgrades in 2026. * Named by Becker's Healthcare as one of the "165 Top Places to Work in Healthcare – 2026. * Atlantic Health Morristown, Atlantic Health Overlook, Atlantic Health Chilton and Atlantic Health Newton all Forbes Top Hospitals for 2026. * Named by Newsweek as one of America’s Greatest Workplaces for Inclusion & Diversity 2025. * Atlantic Health rated LEVEL 9 - 2025 CHIME Digital Health Most Wired. Atlantic Health offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members. Offerings vary based on role level (Team Member, Director, Executive). Below is a general summary, with role-specific enhancements highlighted: Team Member Benefits * Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members) * Life & AD&D Insurance. * Short-Term and Long-Term Disability (with options to supplement) * 403(b) Retirement Plan: Employer match, additional non-elective contribution * PTO & Paid Sick Leave * Tuition Assistance, Advancement & Academic Advising * Parental, Adoption, Surrogacy Leave * Backup and On-Site Childcare * Well-Being Rewards * Employee Assistance Program (EAP) * Fertility Benefits, Healthy Pregnancy Program * Flexible Spending & Commuter Accounts * Pet, Home & Auto, Identity Theft and Legal Insurance ____________________________________________ Note: In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits. Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer. EEO STATEMENT Atlantic Health, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran

Responsibilities

The specialist reviews payer denials and analyzes medical records against clinical guidelines to develop evidence-based appeal letters. They collaborate with physicians and CDI teams to improve documentation and track overturn rates to prevent future denials.