Technical Denial Specialist - FT - Day - Hospital Billing Lawrenceville NJ

Capital Health (US)•Pike, NY

5d•Onsite

About The Position

The Technical Denial Specialist is responsible for research, analysis, and resolution of hospital technical denials within the denials team scope. This role focuses on non-clinical denial types such as authorization and notification issues, payer processing errors, and other technical claim adjudication issues. Ensures denied claims are thoroughly reviewed, corrected, resubmitted, or appealed as appropriate to maximize reimbursement and reduce repeat denial occurrences.

Requirements

High school diploma or equivalent required.
Three years' hospital billing, denials, or claims resolution experience.
Demonstrated experience working technical denial types required.
Strong understanding of hospital billing workflows and payer claim adjudication processes.
Working knowledge of technical denial categories, including authorization, notification, and payer processing issues.
Ability to perform detailed root-cause analysis and identify upstream process failures.
Strong written documentation and organizational skills.
Proficiency with hospital billing systems and payer portals.
Working knowledge of 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 assigned technical denial worklists daily and prioritizes accounts based on timeliness and payer requirements
Conducts appropriate research and analysis to determine the root cause of technical denials.
Executes accurate claim corrections, resubmissions, reconsiderations, or appeals as appropriate.
Performs payer follow-up activities, including portal research and telephone outreach when necessary.
Documents clear, concise, and accurate notes in the hospital billing system to support resolution actions.
Identifies recurring denial trends and escalates findings to leadership with supporting data.
Partners with Patient Access, Utilization Review, Billing, Coding, and Revenue Integrity teams to resolve and prevent repeat denials.
Maintains current knowledge of payer requirements, billing rules, and denial best practices
Supports departmental audits, reporting, and performance improvement initiatives.
Operates computer software efficiently to complete required tasks.
Performs other duties as assigned and adapts to changing departmental demands