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
The Medical Billing and Denials Analyst will be responsible for coordinating workgroups and acting as the central point of contact on how to resolve future denials. This position is a key member of the team that will create workflows to create better outcomes for denials management.
Essential Duties & Responsibilities
- Analyzes outstanding accounts receivable and credits and ensures that these are maintained at the levels expected by Revenue Cycle Leadership.
- Responsible for appealing and defending claims denials, adverse audit results, and sanctions.
- Analysis, track and trend daily, weekly, and monthly denials by payer using denial reporting tools. Maintain a system of reporting that provides timely and relevant information on all aspects of clinical appeals, audits, and compliance issues to Revenue Cycle Leadership. Develops and distributes weekly, monthly and ad hoc reports needed by Revenue Cycle Leadership and Finance.
- Participates in complex projects related to denial initiatives and complex investigations into allegations of billing fraud or abuse, as necessary. Provides support for projects in which Senior Leadership is involved.
- Proactively identifies problems or opportunities for improvements related to clinical orders and/or clinical documentation and makes recommendations to management and/or the perspective departments with high volume/high dollar values.
- Develop, trend, and report monthly and annual statistical reporting dashboard to coincide with departmental and organizational KPIs (Key Performance Indicator).
- Associates Degree preferably in the business or finance field or 4 years of healthcare revenue/billing/denials experience
Licensure, Certification & Registration:
- Epic proficiency or certification in Resolute PB desired
- Requires minimum 2 years of healthcare revenue cycle experience
Skills, Knowledge & Abilities:
- Comprehensive working knowledge of medical/hospital billing practices, billing software, health care insurance, and CMS regulations
- Knowledge of CPT, HCPCS, and ICD-10 coding principles.
- Knowledge of Epic or related hospital ADT/Billing software.
- Thoroughly proficient in data entry using a pc and a variety of electronic systems.
- Ability to read, analyze and interpret financial reports.
- Ability to define problems, collect data, establish facts, draw conclusions, and make sound recommendations.
- Capacity to analyze and think creatively and weigh alternatives.
- Perception of people and an awareness to deal with conflict successfully and attain resolution
- Demonstrates attention to detail.
- Demonstrates proficiency in the use of excel documents.
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.