Clinical Analyst – Appeals

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🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $93.1k - $124.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Beth Israel Lahey Health

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

Healthcare Insurance

Beth Israel Lahey Health is a comprehensive healthcare system providing a wide range of medical services and care options to communities in Massachusetts and New Hampshire. With a network of 14 hospitals, including community hospitals and specialized centers for orthopedic and behavioral health care, they offer personalized care for all health needs. Their services include emergency care, primary care, urgent care, pharmacy services, home care, and more. Dedicated to improving community health and well-being, Beth Israel Lahey Health is committed to research, education, and providing extraordinary care through its 39,000 team members.

📋 Description

• Maintain a system of reporting that provides timely and relevant information on all aspects of clinical appeals, audits, and compliance issues to management • Assist in the tracking and review of payer audit and denial results • Prepare clinical appeals relevant to audits to prove medical necessity and level of care were warranted • Responsible for appealing and defending claims denials, adverse audit results, and sanctions • Conduct regular audits to ensure compliance with billing and documentation requirements • Provide clinical improvement initiatives based on denial analysis • Communicate appeal results to management and revenue cycle leadership

🎯 Requirements

• Associate degree preferably in the business, healthcare, or finance field • In the absence of an Associate’s Degree, an additional 4 years of healthcare revenue cycle experience are required • Minimum of two (2) to three (3) years auditing and familiarity with CPT/HCPCs/DRG coding experience required • Requires minimum 2 years of healthcare revenue cycle experience • Epic Resolute HB desired • Must have sound understanding of ICD-10, and CPT coding systems • Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel • Highly skilled experience and knowledge of Windows-based software including Microsoft Windows, Outlook, Excel, and Access • Possess effective oral and written skills including superb formal presentation skills • Well-developed research skills • Excellent organizational and project management skills • Possess effective time management skills • A thorough understanding and knowledge of Medicare rules and regulations is required • Experience with medical chart review • Ability to read, analyze, and interpret financial reports

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Flexible working hours • Educational materials and training • Ongoing education opportunities • Wellness programs