Denial and Appeals Coordinator- Onsite Passaic, NJ

Job Description – Denial and Appeals Coordinator – Onsite, Passaic, NJ (549785)

Denial and Appeals Coordinator – Onsite, Passaic, NJ

Job Number: 549785

At Scion Health, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day‑to‑day interactions with our patients and teammates.

This is an onsite role and team members are required to work at the Passaic, NJ location.

The Denials & Appeals Coordinator serves as the operational driver for timely and effective denial management, working closely with other members of the team, especially utilization management, to ensure no step is missed in preventing and resolving authorization‑related denials. While not a clinical role, this position is critical in executing the processes that protect revenue and keep patient care moving forward.

Focused on denial prevention, the Denials & Appeals Coordinator monitors the concurrent review process for continued stay authorizations, tracking potential issues and ensuring timely follow‑up for designated facilities. This role actively tracks, organizes, and reports denial activity, partnering with case management teams, the Centralized Business Office, managed care, facility controllers, Clinical Denials Management, and Regional leadership to ensure alignment and swift resolution.

By acting as a central point of coordination and follow‑through, the Denials & Appeals Coordinator turns strategy into action—ensuring tasks are completed, deadlines are met, and communication flows between all parties. This role demonstrates accountability, attention to detail, and a commitment to quality improvement, problem solving, and productivity enhancement in an interdisciplinary model.

• Serves as a key team member of the new Central Access and Authorizations Team (CAAT), acting as a subject matter expert on denial prevention and coordination.
  • Works with facility to gather clinical information from medical record; may include printing and scanning into required systems.
  • Ensures all denial‑related documentation is complete, accurate, and submitted within required time frames.
  • Collaborates with CAAT, Business Development, Case Management, and Clinical Teams in the denial management process.
  • Coordinates and schedules peer‑to‑peer physician consults as needed; may work with case management or directly with the physician advisory group.
  • Monitors and tracks insurance denials; identifies trends in the data.
  • Communicates authorization outcomes to appropriate personnel (hospital and Centralized Business Office).
  • Manages denial root cause analysis efforts as requested – capturing lessons learned, identifying training opportunities, and providing appropriate communication and follow‑up to the teams.
• Monitors concurrent review processes for continued stay authorizations to identify potential denial risks.
• Supports the denials management process:
  • Compiles data for trend analysis by hospital, payer, or region.
  • Monitors and tracks total certified days for managed payers (commercial, managed government, and Medicaid) and communicates missing certifications to hospital personnel.
  • Identifies trends and opportunities with specific facilities, payers, and staff members related to the concurrent review process and denials.
  • Compiles and communicates reports for facility and leaders on denial trends for continuous improvement opportunities.
• Supports ongoing analytics and data reporting requirements.
• Maintains a working knowledge of government and non‑government payor practices, regulations, standards, and reimbursement.
• Maintains clinical knowledge to support the utilization management team.
• Participates in continuing education/professional development activities.
• Learns and develops full knowledge of the CAAT admission processes and actively seeks to continuously improve them.
• Learns and fully understands scheduling and pre‑registration routines in Meditech and any other referral platform utilized…