Appeals Specialist, Patient Accounts

University Hospital•Newark, NJ

5d•$61,039 - $87,183

About The Position

The primary function of the Appeals Specialist is to support the Utilization Review (UR) Appeals process within the Department of Patient Accounts by providing follow-up and administrative assistance. This role involves entering, tracking, and analyzing appeal-related data, coordinating with external managed care organizations, physicians, and case managers, and assisting in the preparation of appeal documentation. The Appeals Specialist is also responsible for maintaining detailed logs and generating reports as needed.

Requirements

Minimum of three (3) years of administrative support experience, preferably in a hospital or healthcare setting
Experience in report writing and data analysis required
Proficiency in developing and maintaining databases
Skilled in using various software applications
Proficient in Microsoft Word, Excel, and PowerPoint
Strong oral and written communication skills required
Excellent analytical and organizational abilities
Ability to work independently and collaboratively as part of a team
Equivalent related experience may be considered in place of the degree on a year-for-year basis

Nice To Haves

Bachelor’s degree in Business, Finance, Healthcare, or a related field required
Background in medical records, social work, finance, or utilization management preferred

Responsibilities

Provides administrative support for the Utilization Review (UR) Appeals process within the Department of Patient Accounts
Performs follow-up on appeal cases to ensure timely and accurate resolution
Inputs, tracks, and analyzes appeal-related data for reporting and trending purposes
Collaborates with external managed care organizations, physicians, and case managers to facilitate the appeals process
Assists in preparing necessary documentation for appeals submissions
Maintains accurate and organized appeal logs
Generates reports as assigned to support department operations and compliance