Beth Israel Lahey Health is hiring a Denial Specialist 3 to resolve high-dollar, aged, and denied claims for complex physician specialties. In this remote role, you will identify root causes of denials, manage appeals, and work to prevent future denials through education and process improvement.
What You'll Do
- Resolve assigned back-end high-dollar, complex, and aged physician billing denials.
- Review and complete daily work queue volume for related denials.
- Respond to customer service inquiries regarding physician billing patient accounts.
- Work claim rejections from payors that prevent claims submission.
- Update the Electronic Health Record (EHR) patient registration and initiate rebilling or corrections.
- Research active insurance coverages for self-pay balances to prevent missed cash collection.
- Collaborate with internal departments, third-party vendors, and insurance carriers to resolve billing issues.
- Work with Hospital, Professional, and Home Health Billing Teams to identify inappropriate billing trends.
- Apply knowledge of Hospital and Professional Billing in a Single Billing Office (SBO) environment.
- Proactively identify problems and opportunities for system, training, and practice improvements.
- Assist in developing reporting to identify trends for educational initiatives.
- Complete assignments per turnaround standards and report unfinished work to the Manager.
- Attend meetings and serve on committees as requested.
- Achieve exemplary audit results and consistently exceed productivity standards.
- Provide and promote ideas for process improvements within the Central Billing Office.
- Independently work on resolving complex claims issues, denials, and appeals.
- Complete assigned projects and research.
- Support mentoring and training for new and existing Accounts Receivable staff.
What We're Looking For
- Associate degree or equivalent experience.
- Three (3) years of experience in a denial management environment.
- Experience in training and staff development.
- Strong knowledge of third-party payor reimbursement, eligibility verification, and government/payor compliance rules.
Nice to Have
- Billing Certification – EHR Professional/Hospital Billing Admin (Proficiency, Proficiency w/ Honors, or Certification).
Technical Stack
- Electronic Health Record (EHR) system.
Team & Environment
You will work directly with Supervisors and Managers and report to the Manager of Revenue System Operations.
Benefits & Compensation
- Compensation: $24.15 - $32.50 per hour.
- In-service meetings, education programs, and conferences for professional growth and development.
Work Mode
This is a fully remote position.
Beth Israel Lahey Health is an Equal Opportunity Employer/Veterans/Disabled.
