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Our Future Begins With You

As a health care organization, Lahey Hospital and Medical Center is committed to providing high quality, safe patient care. As an employer, Lahey is committed to ensuring a professional environment where every staff member is encouraged to excel. green decorative barWith a team approach to care, physicians and nurses at Lahey work side-by-side with allied health professionals, medical technologists, and administrative and support staff to deliver on our mission. Lahey encourages learning and growth at all levels, and we offer competitive salaries and benefits.

PFS Denial Specialist II

Job ID 142591 Date posted 11/13/2017


Position Summary:
The PFS Denial Specialist II role is vital to ensure that hospital denied accounts are thoroughly reviewed for any opportunity to correct, re-file and or appeal claims for re-processing and reimbursement. The role also includes review and rework of all coding and charge related denials, as well as analysis and education to reduce denials and increase hospital reimbursement.

Essential Duties & Responsibilities including but not limited to:

Reviews and completes continuous daily work queue volume of Coding and Charge Related Denials.

Proactively identifies problems or opportunities for improvements related to orders and/or documentation and makes recommendations to Manager and/or the perspective departments with high volume/high dollar values.

Utilize CAC or other electronic coder assisting tools available to validate proper coding of CPT/HCPCS/ICD-9/ICD-10 codes.

Assists in the development of reporting mechanisms to identify trends and track so that education can be performed to reduce and/or resolve high dollar/high volume values.

Develop strong working relationships with other Lahey Health department personnel to promote clear communication and welcomed education for reimbursement enhancement.

Keeps abreast of all government and payer level hospital coding, billing and reimbursement rules, regulations and guidelines

Promotes Teamwork and maintains a positive atmosphere when communicating with fellow departmental colleagues both oral and written.

Organizational Requirements:
Maintain strict adherence to the Lahey Hospital and Medical Center Confidentiality policy.
Incorporate Lahey Hospital and Medical Center Standards of Behavior and Guiding Principles into daily activities
Comply with all Lahey Hospital and Medical Center Policies.
Comply with behavioral expectations of the department and Lahey Hospital and Medical Center.
Maintain courteous and effective interactions with colleagues and patients.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
Participate in departmental and/or interdepartmental quality improvement activities.
Participate in and successfully completes Mandatory Education.
Perform all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:
Education: High School Diploma or equivalent.
Bachelor?s degree or 4 years? experience in a hospital billing/coding, Denial Managment environment related field.
Must have experience in either a hospital related billing, claims follow up environment or hospital coding.

Licensure, Certification & Registration: None required

Experience: Experience using patient accounting computer systems and Excel spreadsheets. Working knowledge of third party payer reimbursement, coding guidelines, and government and payer compliance rules

Skills, Knowledge & Abilities: Required

About Lahey Health

At Lahey Hospital & Medical Center, as one of the world's premier health care organizations, we provide superior health care leading to the best possible outcome for every patient. We exceed our patients' high expectations for service each day. We also help advance medicine through research and the education of tomorrow's health care leaders

We care for our patients with compassion and openness, unsurpassed expertise, a drive for continuous learning improvement, and with respect, caring, teamwork, excellence and commitment to doing our personal best.

Join our team and our mission of excellence by applying today!
How To Apply

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