Clinical Analyst – Appeals

🕒 June 11

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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. • Participates in complex projects related to denial initiatives. • Provides support for projects in which senior managers are involved. • Assist in the tracking and review of payer audit and denial results. • Prepare appeal requests as appropriate. • Responsible for appealing and defending claims denials, adverse audit results, and sanctions. • Analysis, tracking, and trend of daily, weekly, and monthly denials by payer using denial reporting tools. • Perform process review of denials by hospital departments, • Draft, revise, and enforce BILH policies and procedures as they apply to appeal and audit functions. • Conduct regular audits to ensure that BILH is coding, billing, and documenting completely and accurately and is in compliance. • Analyzes work queues and other system reports identifies denial/non-payment trends, and reports and provides recommendations to the Revenue Cycle Leadership. • Proactively identifies problems or opportunities for improvements related to clinical orders and/or clinical documentation.

🎯 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. • Applicable clinical or professional certifications/licenses such as RN, LPN, CPC, RT, MT, and RPH are highly desirable. • Minimum of two (2) to three (3) years auditing and familiarity with CPT/HCPCs/DRG coding experience required. • Clinical education and/or utilization review experience is strongly preferred. • Requires minimum 2 years of healthcare revenue cycle experience • Epic Resolute HB desired

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Professional development opportunities