Patient Access Reimbursement Specialist

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Location: Burlington, MA
Job ID: 160798-1A
Date Posted: Apr 28, 2020
Category: Specialist

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Job Description

Welcome To

Welcome to Lahey Hospital & Medical Center, part of Beth Israel Lahey Health. Lahey Hospital & Medical Center is a world-renowned tertiary medical center known for its innovative technology, pioneering medical treatment and leading-edge research. A teaching hospital of Tufts University School of Medicine, the hospital provides quality health care in virtually every specialty and subspecialty, from primary care to cancer diagnosis and treatment to kidney and liver transplantation. It is a national leader in a number of health care areas, including stroke, weight management and lung screenings, among many others. Lahey also helps to advance medicine through research and the education of tomorrow's health care leaders.

About the Job

Position Summary:  Under the general direction of the Admissions Supervisor, Manager, and Director, is responsible for managing insurance denials for Lahey Clinic Patient Access Services.  Assists department managers with establishing programs, policies and procedures to maximize reimbursement by minimizing denials.

Essential Duties & Responsibilities including but not limited to:

  • Monitors denial database to ensure timely response to denied cases; prepares and submits appeals, provides follow-up on cases until resolution has been achieved.  Initiates departmental write-off policy, as appropriate
  • Cultivates, maintains and enhances relationships with third party payers; maintains a strong knowledge base of all payers’ processes, guidelines and requirements and of all payers’ system limitations.
  • Ensures completion of all daily operational functions in Admissions work areas by monitoring for unfinished work.
  • Oversees all Inpatient, Observation and Surgical day care denials.
  • Contacts, investigates and resolves SDC, OBS and INP denials.
  • Dictates appeal letters in a timely manner.
  • Communicates closely with appropriate departments in order to resolve any outstanding denial issue.
  • Works with department leadership team to identify opportunities for improved operational functions and processes.
  • Takes daily assignments in any operational area as needed, performing operational responsibilities including, including interviewing patients to obtain demographic, employment, insurance and financial information; obtaining ICD9 and CPT codes for all admissions, obtaining prior approval for all E.D. visits and/or future procedures and entering this information into the Lahey clinic Medical Center data base and if/when applicable, use of the available insurance verification tools to obtain verification of the insurance coverage; scheduling preoperative consults and/or tests, checking patients in on the surgical and preoperative reservation list, monitoring and controlling bed assignments, preparing admission/registration forms, and performing other clerical duties related to admission/registration, discharge, and transfers.
  • Takes daily responsibility for observing process areas, identifying backlogged work functions and       taking or recommending corrective actions
  • Completes daily monitors to ensure integrity of departmental work output.
  • Monitors departmental areas to assure rapid customer response and ensure efficient patient flow.
  • Incorporates Lahey Clinic Guiding Principles, Mission Statement and Goals into daily activities. 
  • Complies with all Lahey Clinic Policies.
  • Complies with behavioral and dress expectations of the department and Lahey Clinic.
  • Maintains courteous and effective interactions with colleagues and patients.
  • Demonstrates an understanding of the job description, performance expectations, competency assessment, and departmental goals and expectations
  • Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
  • Participates in departmental and/or interdepartmental quality improvement activities.
  • Participates in and successfully completes required Lahey Clinic and position specific educational programs
  • Performs all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:

Education: High school diploma or GED

Skills, Knowledge & Abilities: Working knowledge of Meditech, IDX, PICIS, LCMC, and Documentum systems, as well as of ICD9 and CPT coding.  Proven ability to work well with peers and customers.

Experience:  Knowledge of all hospital admissions task functions, including insurance-specific on-line verification/precertification systems, usually acquired through a minimum of one year of experience in a hospital admissions department.

SHIFT: 40 hours, 1st shift

About Us

Beth Israel Lahey Health is an integrated system providing patients with better care wherever they are. Care informed by world-class research and education. We are doctors and nurses, technicians and social workers, innovators and educators, and so many others. All with a shared vision for what healthcare can and should be. We are committed to attracting, developing and retaining top talent. We strive to create a diverse and inclusive workplace that reflects the communities in which we work and serve. With a team approach to care, we encourage learning and growth at all levels and offer competitive salaries and benefits.

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