Manager Technical Denials - FT - Day - Revenue Integrity & Denials Mgmt 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:

$94,140.80 - $122,990.40

Scheduled Weekly Hours:

40

Position Overview

The Manager of Technical Denials is responsible for the oversight and management of technical denial activities within the denials team scope, including authorization and notification issues, payer processing errors, and other non-clinical denial types. This role ensures consistent resolution workflows, accurate root-cause identification, and sustained denial prevention through cross-functional collaboration.

MINIMUM REQUIREMENTS
Education:    Bachelor's degree. A High School diploma or equivalent and additional years of experience may be considered in lieu of a formal Bachelor's degree.
Experience:    Four years of progressively responsible experience in hospital billing, denials management, claims resolution or related revenue cycle functions if accompanied by a Bachelor's degree. Eight years progressively responsible experience in hospital billing, denials management, claims resolution or related revenue cycle functions if accompanied by a high school diploma or equivalent. Demonstrated experience managing or leading teams is preferred.
Other Credentials:    
Knowledge and Skills:    • Strong understanding of technical denial categories (authorization, notification, payer processing, claim edits within scope) • Deep knowledge of hospital billing workflows and payer claim adjudication processes • Proven ability to perform and teach root-cause analysis and corrective action methodologies • Strong organizational and communication skills • Ability to work cross-functionally with Patient Access, UR, Billing, Coding, and Revenue Integrity
Special Training:    Proficient in Microsoft Office. Working knowledge of insurance contracting principles and payer administrative policies.
Mental, Behavioral and Emotional Abilities:    Ability to provide leadership and definition to a new team. Must be skilled in management to provide guidance as priorities change. 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? Yes

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

ESSENTIAL FUNCTIONS
Oversees daily technical denial operations, ensuring timely and accurate resolution of assigned denial types
Establishes standardized research, correction, resubmission, and escalation workflows
Defines and maintains scope boundaries between denials, billing, coding, and revenue integrity functions
Reviews denial trends and root causes to identify upstream process failures
Partners with operational leaders to implement sustainable prevention strategies and process improvements
Ensures appropriate documentation and system notes are maintained in accordance with departmental standards
Collaborates with payor relations team to support communications and escalations related to recurring technical denial issues
Monitors productivity, quality, and outcomes; provides coaching and performance feedback to staff
Maintains current knowledge of payer requirements, billing rules, and denial best practices
Supports reporting and analytics efforts related to technical denial performance and prevention
Performs other duties as assigned

PHYSICAL DEMANDS AND WORK ENVIRONMENT
Frequent physical demands include: Keyboard use/repetitive motion

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 , Wrist position deviation , Pinching/fine motor activities

Continuous physical demands include: Sitting , Talk or Hear

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

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate 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.