Appeals Specialist

Overview

About the Role

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.

Responsibilities

What You’ll Do

• 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

Qualifications

What You’ll Bring

Preferred:

• Bachelor’s degree in Business, Finance, Healthcare, or a related field required

• Minimum of three (3) years of administrative support experience, preferably in a hospital or healthcare setting

• Experience in report writing and data analysis required

• Background in medical records, social work, finance, or utilization management preferred

• 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

What We Offer

• Medical & Prescription Drug Coverage
• Dental & Vision Insurance
• Health Savings Account (HSA) & Flexible Spending Account (FSA)
• Short- & Long-Term Disability Insurance
• Pension Plan
• Pet Insurance
• Employee Assistance Program (EAP)
• Professional Development

Compensation

The expected salary range for this position is PS/22S: $61,039.00 - $73,322.00 - $87,183.00 per year in accordance with the New Jersey Pay Transparency Law; final compensation will be commensurate with experience and qualifications.

About Us

University Hospital is one of the nation’s leading academic medical centers. As the principal teaching affiliate of Rutgers New Jersey Medical School and the only state-certified Level 1 Trauma Center in Northern New Jersey, University Hospital is training the next generation of physicians and advancing science to discovery while taking exceptional care of patients, regardless of their financial situation.

Apply Today

We encourage candidates from all backgrounds to apply. If you want to grow your career in healthcare while serving a vibrant community, we’d love to meet you.

University Hospital offers a competitive salary & comprehensive benefits package. Affirmative Action/Equal Opportunity Employer, M/F/D/V. For more information, visit  www.uhnj.org/hrweb.