Appeal Resolution Specialist jobs in the United States

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Appeal Nurse Specialist will be responsible for the timely review and submission of appeals for denied managed care inpatient and/or outpatient claims to insurance companies for reconsideration of denials and/or level of care change determinations. Gathers and evaluates the information for appeals of Managed Care audits, clinical and technical denials by utilizing various Epic and legacy systems for Hackensack Meridian Health (HMH) hospitals. Responsible for following all regulatory compliance requirements. Serves as a functional expert and liaison to other departments within the hospital system (i.e.: patient access, patient accounting, and Care Management).