Denial Specialist Professional Billing

Beth Israel Lahey Health; Burlington (VT); On-site; USD 50,000 - 65,000; Full time

Job summary

A leading healthcare organization is seeking a Denial Specialist to manage billing and payment processes. The role involves analyzing third-party payments, resolving denials, and ensuring timely payment. Candidates should have experience in healthcare billing and a high school diploma. Join a dedicated team focused on improving billing efficiency and compliance.

Qualifications

• 2-3 years of healthcare denial experience.
• Knowledge of third-party payor reimbursement and compliance rules.

Responsibilities

• Monitor days in A/R and maintain expected levels.
• Analyze denial trends and report them.
• Initiate claim rebilling and appeals as needed.

Skills

Healthcare Denial Experience

Knowledge of Compliance Rules

Education

High School Diploma

Billing Certification

Job description

Join to apply for the Denial Specialist Professional Billing role at Beth Israel Lahey Health.

Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

The Denial Specialist will identify, review, and interpret third-party payments, adjustments, and denials. Initiates corrected claims, appeals, and analyzes unresolved third-party and self-pay accounts, initiating contacts and negotiating appropriate resolution (internal and external) to ensure timely and maximum payment. Manually and electronically applies for insurance payments and works insurance overpayments, credits, and undistributed balances. Works directly with the Billing Supervisor to resolve complex issues and denials through independent research and assigned projects.

Job Responsibilities:

1. Monitor days in A/R and ensure they are maintained at management's expected levels.
2. Analyze work queues and system reports to identify denial/non-payment trends and report them.
3. Navigate the hospital billing system to identify paid claims or root causes of denial.
4. Respond professionally to incoming insurance/office calls and resolve issues.
5. Establish and maintain communication with third-party payor representatives.
6. Review claim forms for accuracy and correct all claim/charge denials and edits.
7. Initiate claim rebilling, appeals, or corrections as needed.
8. Evaluate delinquent third-party accounts and process based on protocols.
9. Review and update accounts for write-offs and refunds.
10. Keep informed of relevant regulations and maintain billing knowledge.
11. Complete assignments per turnaround standards and report unfinished tasks.
12. Attend meetings, serve on committees, and promote process improvements.
13. Assist with complex claims issues, denials, appeals, and credits.
14. Resolve unapplied cash with the cash team.
15. Complete assigned projects and research.

Secondary Functions:

1. Participate in professional growth activities.
2. Maintain confidentiality and exercise care in equipment use.
3. Perform routine maintenance and keep work area organized.
4. Refer complex issues to the Billing Supervisor.
5. Report irregularities and accept new tasks as needed.
6. Support department efficiency through teamwork.
7. Perform similar or related duties as assigned.

Qualifications:

• High School diploma required.
• Billing Certification preferred.
• 2–3 years of healthcare denial experience.
• Knowledge of third-party payor reimbursement, eligibility verification, and compliance rules.

Beth Israel Lahey Health requires all staff to be vaccinated against influenza and COVID-19 as a condition of employment.