Inpatient Clinical Denial Specialist - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ

Capital Health (US)•Pike, NY

1d•Onsite

About The Position

Responsible for administrative management, tracking, and coordination of inpatient clinical denials, including patient status determinations, medical necessity denials, and readmission-related denials. Ensures inpatient clinical denial cases are properly triaged, routed, documented, tracked, and prepared for appeal in accordance with payer requirements, while partnering with clinical and operational resources to support timely resolution and denial prevention.

Requirements

High school diploma or equivalent required.
Three years' hospital billing, denials management, utilization review support, or related revenue cycle experience.
Experience working inpatient clinical denials, patient status determinations, or medical necessity denials strongly preferred.
Working knowledge of inpatient clinical denial categories, including medical necessity, patient status, and readmissions
Familiarity with utilization review processes and clinical documentation workflows
Ability to perform detailed tracking, documentation, and inventory management across multiple appeal levels
Strong organizational skills and attention to detail
Ability to identify root causes and recurring denial drivers
Strong written communication skills for documentation and internal coordination
Proficiency with hospital billing systems, EMR navigation, and payer portals
Proficiency with Microsoft Office applications, including Excel.
Must have ability to meet deadlines and attention to detail.
Must demonstrate good judgment.
Must be metric-driven and results oriented.

Nice To Haves

Associate or bachelor’s degree in healthcare or business-related field preferred.

Responsibilities

Reviews and triages inpatient clinical denials, including medical necessity, patient status, and readmission-related denials
Routes cases to appropriate clinical resources (Clinical Appeals RN, CDI, UR/Case Management, Physician Advisor) based on denial type and appeal viability
Maintains accurate inpatient clinical denial inventories, including deadlines, appeal levels, documentation status, and outcomes
Coordinates medical record requests, appeal packet preparation logistics, and submission tracking
Ensures compliance with payer requirements, timelines, and documentation standards for inpatient clinical denials
Performs payer follow-up activities, including portal research and telephone outreach as needed
Documents clear, concise, and accurate notes in the hospital billing system related to denial actions and status
Identifies recurring inpatient clinical denial trends by payer, service line, unit, or provider and escalates findings to leadership
Supports denial prevention initiatives by partnering with Utilization Review, Case Management, CDI, and clinical leadership
Maintains current knowledge of payer inpatient denial practices and appeal processes
Performs other duties as assigned and adapts to changing departmental demands