Clinical Appeals & Audit Analyst

Caza Collective; Boston (MA); On-site; USD 93,000 - 125,000; Full time

Job summary

Beth Israel Lahey Health (BILH) is seeking a Clinical Analyst in the Patient Financial Services group to handle clinical appeals and audit processes for both inpatient and outpatient settings. You will educate providers on coding, billing, and documentation requirements, support payer audits, and prepare clinical appeals proving medical necessity and level of care.

The role requires expertise in ICD-10/CPT coding, auditing, and healthcare revenue cycle, with collaboration across departments to

Qualifications

• CCS and/or CDIP required.
• Associate degree preferably in the business, healthcare, or finance field.
• In the absence of an Associate's Degree, an additional 4 years of healthcare revenue cycle experience are required.
• Minimum of two (2) to three (3) years auditing and familiarity with CPT/HCPCs/DRG coding experience required.
• Clinical education and/or utilization review experience is strongly preferred.
• Requires minimum 2 years of healthcare revenue cycle experience.
• Epic Resolute HB desired.

Responsibilities

• Maintain reporting on clinical appeals, audits, and compliance for Revenue Cycle Leadership.
• Participate in complex denial initiatives and support senior managers.
• Assist in tracking payer audit and denial results and prepare appeals.
• Appeal and defend denials, adverse audit results, and sanctions.
• Analyze denial trends and report to leadership for improvements.
• Draft and enforce policies related to appeal and audit functions.
• Conduct audits to ensure proper coding, billing, and documentation.

Skills

ICD-10 & CPT

Auditing

Medical coding

Communication skills

Team collaboration

Education

CCS/CDIP

Associate degree in business/healthcare/finance

Additional 4 years revenue cycle experience

Tools

Excel

Access

Outlook

Job description

Beth Israel Lahey Health (BILH) is seeking a Clinical Analyst in the Patient Financial Services group to handle clinical appeals and audit processes for both inpatient and outpatient settings. You will educate providers on coding, billing, and documentation requirements, support payer audits, and prepare clinical appeals proving medical necessity and level of care.

The role requires expertise in ICD-10/CPT coding, auditing, and healthcare revenue cycle, with collaboration across departments to