PFS Denial Specialist II

Location: Burlington, MA
Job ID: 151601-1A
Date Posted: Dec 5, 2018

Job Description

Welcome To

Lahey Health Shared Services is part of a vibrant and growing health care system, recognized as a trailblazer in medicine and a standard bearer in patient experience. It includes an award-winning academic medical center, a superb constellation of community hospitals, home care services, rehabilitation facilities and more.

We are committed to attracting, developing and retaining top talent in a market long recognized and revered as a global leader in health. With a team approach to care, we encourage learning and growth at all levels, and we offer competitive salaries and benefits. We adhere to the principles of a just and fair work environment for all colleagues, where respect is foundational and performance is rewarded.

About the Job

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 payor 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.

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.

Experience:

  • 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.

About Us

The Lahey Model of Care—right care, right time, right place—is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.

Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.