Denials Representative -Full-Time
Location: Hackensack, NJ, United States
Pay Range: $22.00/hour - $25.30/hour
Description
Denials Representative
Welcome to Holy Name, a medical center where innovation is not just a goal — it's a commitment. Here, medical excellence thrives, allowing hope to reign supreme and leaving no room for fear. At our hospital, every patient is cared for with undivided attention — because healing every soul is our sole focus. Holy Name is New Jersey's only independent Catholic health system, comprising a 361-bed acute care hospital, a renowned cancer center, a state-of-the-art fitness center, a residential hospice, a prestigious nursing school, and an extensive physician network. Healing at Holy Name goes beyond medicine and technology – it is infused with faith, conviction, compassion, and a commitment to educating the next generation of healthcare professionals through a variety of residency and educational programs. Our mission to provide care for the body, mind, and soul spans education, prevention, diagnosis, treatment, rehabilitation, and overall wellness. This is at the core of who we are and what we do, and we've done it this way across generations, every single day, for nearly 100 years. Every innovation, medical breakthrough, and groundbreaking treatment is powered by some of the best minds in medicine, ensuring nothing is left on the table or the road to recovery.
The Denials Representative is responsible for investigating, appealing, and resolving denied or underpaid insurance claims to maximize reimbursement. This position collaborates with internal departments and insurance payers to resolve claim issues, identify denial trends, and support process improvements that strengthen the hospital's revenue cycle.
Review and investigate denied and underpaid insurance claims to determine the cause of non-payment
Research patient accounts using medical records, coding, documentation, authorizations, and payer guidelines
Prepare, submit, and monitor appeals in accordance with payer requirements and filing deadlines
Communicate with insurance companies to resolve claim issues and secure appropriate reimbursement
Collaborate with coding, patient access, utilization management, case management, and billing teams to resolve denials
Document account activity and maintain accurate records within the patient accounting system
Monitor assigned denial inventory and ensure timely follow-up through final resolution
Identify denial trends and recommend process improvements to reduce future denials
Maintain current knowledge of payer policies, billing regulations, and reimbursement guidelines
Assist with audits, quality improvement initiatives, and other revenue cycle projects
Comply with HIPAA, hospital policies, and all applicable federal and state regulations
Experience Qualifications
Knowledge, Skills, and Abilities
· Strong analytical, problem-solving, and critical thinking skills |
· Excellent attention to detail, organization, and time management |
· Working knowledge of Medicare, Medicaid, managed care, and commercial insurance reimbursement |
· Familiarity with medical terminology and coding concepts, including ICD-10-CM, CPT, and HCPCS |
· Ability to interpret EOBs, remittance advice, payer policies, and reimbursement guidelines |
· Experience with electronic health records (EHRs), patient accounting systems, and payer portals |
· Effective verbal and written communication skills with the ability to collaborate across departments and with insurance representatives |
· Ability to manage multiple priorities, work independently, and meet deadlines in a fast-paced environment |
· Commitment to professionalism, customer service, confidentiality, and continuous process improvement |
At Holy Name, we believe in rewarding every team member with more than a paycheck—we invest in your future and well-being. Full-time and part-time employees have access to a comprehensive benefits package designed to support your health, financial security, and quality of life. We offer low-cost medical coverage with generous employer contributions, dental and vision plans, discounted prescriptions, and access to on-site child care. Additional benefits include 401(k) matching, tuition reimbursement, paid time off, flexible spending accounts, legal and voluntary coverage options, life insurance, and free on-site parking. If you are hired at Holy Name, your final base compensation will be determined based on factors such as employment status (Full/Part-Time or Per Diem) skills, education, and/or experience. In addition to those factors – we believe in the importance of pay equity and consider any internal equity of our current team members as a part of any final offer.
Holy Name is a mission-driven facility whose quality standards and philosophy are rooted in the principles of its founders, the Sisters of St. Joseph of Peace. Those principles are exercised daily by the Medical Center's dedicated and talented staff members. Holy Name is an Equal Opportunity Employer.
