Clinical Analyst – Appeals

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Beth Israel Lahey Health

Site WebLinkedInTous les Emplois

10 000+ employés

⚕️ Assurance santé

Healthcare Insurance

Beth Israel Lahey Health est un système de santé complet offrant une large gamme de services médicaux et d'options de soins aux communautés du Massachusetts et du New Hampshire. Avec un réseau de 14 hôpitaux, incluant des hôpitaux communautaires et des centres spécialisés pour les soins orthopédiques et de santé comportementale, ils offrent des soins personnalisés pour tous les besoins de santé. Leurs services incluent les soins d'urgence, les soins primaires, les soins d'urgence, les services de pharmacie, les soins à domicile, et bien plus encore. Dévoué à l'amélioration de la santé et du bien-être communautaires, Beth Israel Lahey Health s'engage dans la recherche, l'éducation, et offre des soins extraordinaires grâce à ses 39 000 membres de l'équipe.

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.

🎯 Exigences

• 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

🏖️ Avantages

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