Overview:

Atlantic Health System is seeking a Denials Nurse Manager within our Revenue Integrity Department.

The Denials Nurse Manager reports to the Director of Revenue Integrity. The position will be responsible for developing and managing an in-house denial management program and meeting the annual goals of the program. Manage the current department and re-engineer current workflows for optimum efficiency. In addition, the manager in conjunction with the vendor and physician advisor will be responsible for feedback to clinical departments and case management to ultimately decrease the number of denials.

Responsibilities:

  • Develop the denials department and create workflows for in-house submission of denials. Ultimately, developing an in-house appeals department
  • Determine root cause of denials
  • Establish and manage relationships with AHS leaders, facilitate regular meetings to present, and review denials information
  • Effectively manage the department’s workflow processes, set productivity and quality standards, and ensure denied claims are submitted and followed up in a timely manner
  • Understand explanation of benefits from payors in all areas of non-governmental insurance claims
  • Analyze hospital claims data to identify contractual underpayments, denials, and billing errors
  • Make billing adjustments in system based on outcome of denial
  • Submit information to payors as necessary and follow up with payors on in-house submitted denials
  • Manage assigned work queues (Revenue integrity and denials)
  • Working with the department staff provide monthly denial reports to department manager, clinical departments, and case management
  • Set up and participate in vendor and department meetings/teleconferences

Qualifications:

Education:
  • BSN required or degree in related field
License/Certificaiton:
  • NJ Licensed Registered Nurse
Relevant Information:
  • 3-5 years of denials management experience including submitting appeals to payors
  • 3-5 years of experience managing people
  • Excellent problem solving and data analysis skills
  • Experience working with Physician Advisors and Case Management department
  • Ability to search and understand Payer’s medical policies
  • Proficient in contract language
  • Understand EOBs
  • Planning and organizational skills that gives the candidate the ability to multi-task, perform detailed tasks with efficiency and accuracy
  • Proficient in MS Office particularly in Excel, including Pivot tables

About Us:

Atlantic Health System aims to deliver the highest quality, safety and care combined the best experience for our patients and their families. We are confident that you will find success within Atlantic Health System, which has been named for the 14th year in a row to Fortune’s “Top 100 Best U.S. Companies to Work For” list. We believe you will find that our culture of collaboration and care exemplifies the value we place on our patients, their families and our employees.

EEO Statement:

Atlantic Health System, 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 status.