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

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

Scheduled Weekly Hours:

Position Overview

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.

MINIMUM REQUIREMENTS
Education: High school diploma or equivalent required. Associate or bachelor’s degree in healthcare or business-related field preferred.
Experience: Three years' hospital billing, denials, or claims resolution experience. Demonstrated experience working technical denial types required.
Other Credentials:
Knowledge and Skills: 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.
Special Training:
Mental, Behavioral and Emotional Abilities: Must have ability to meet deadlines and attention to detail. Must demonstrate good judgment. Must be metric-driven and results oriented.
Usual Work Day: 8 Hours
Reporting Relationships
Does this position formally supervise employees? No

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

ESSENTIAL FUNCTIONS
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

PHYSICAL DEMANDS AND WORK ENVIRONMENT
Frequent physical demands include: Sitting , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion , Talk or Hear

Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl

Continuous physical demands include:

Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Moderate Depth Perception, Moderate Hearing
Anticipated Occupational Exposure Risks Include the following: N/A

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.