Job Details

Denial Analyst - Hospital Billing (Remote)

When you join the growing BILH team, youre not just taking a job, youre making a difference in peoples lives. The Revenue Cycle Denial Analyst is charged with coordinating the analysis and effective resolution of denied claims in order to reduceoverall denials and increase revenue. This includes interpreting payment and denial data to line?item detail, identifying payer and coding trends, risks, and opportunities, and implementing operational or systematic improvements.

Essential to this position are strong quantitative, analytical, and organizational skills. Excellent communication and interpersonal skills are required to interpret, communicate, and educate others.

Responsibilities

• Prioritize and manage the resolution of denied claims with third?party payers.
• Research, develop, and maintain a solid understanding of payer requirements, including filing limits, claim processing logic, coordination of benefits, patient responsibility, and authorization requirements.
• Triage denied claims to identify those that should be appealed.
• Write timely, comprehensive, and compelling appeals to third?party payers to overturn denials.
• Follow up on filed appeals via telephone, writing, or the payer website.
• Organize, maintain, and update the access payer database to track issues needing action and to prevent recurrence.
• Apply findings to internal systems and workflows such as pre?billing edits and system automation.
• Perform ongoing analysis to determine the root cause of denials and make well?thought?out recommendations for workflow, operational, or systemic changes.
• Maintain action plans for improvement and compile, maintain, and distribute reports to management on appeal success and root?cause analysis.
• Serve as a department resource related to denials and payer requirements.

Qualifications

• High school diploma or GED required; bachelors degree preferred.
• 13 years of related work experience.
• Advanced skills with Microsoft applications (Outlook, Word, Excel, PowerPoint, Access) and other web?based applications; ability to produce complex documents, perform analysis, and maintain databases.
• Preferred: 35 years of healthcare related experience.

Competencies

• Decision Making: Ability to make decisions guided by general instructions and practices, able to recommend solutions for moderate?complexity problems.
• Problem Solving: Ability to address highly varied, complex, non?recurring problems using innovative, creative, and lean diagnostic techniques.
• Independence of Action: Ability to follow precedents and procedures, set priorities, and seek assistance when necessary; work progress monitored by supervisor/manager.
• Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
• Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families, and external customers.
• Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures, and policies and apply them in varied situations.
• Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful environment and improving workflows.
• Customer Service: Ability to provide high?level customer service to patients, visitors, staff, and external customers in a professional, respectful manner using active listening and problem?solving skills.

Physical Nature of the Job

Sedentary work; occasional lifting of up to 10 pounds. Sit most of the time; walking and standing required only occasionally.

Pay Range

$52,749.00 $70,993.00 USD. The pay range listed is the annual base salary range the organization expects to pay for this position. Actual compensation is determined based on factors such as seniority, education, training, experience, relevant certifications, location, and job responsibilities.

Vaccination Requirement

All staff must be vaccinated against influenza (flu) as a condition of employment.

Equal Opportunity Employer

Beth Israel Lahey Health is an Equal Opportunity Employer. Veterans and disabled individuals are encouraged to apply.