Denials & Appeals Specialist, Medical Billing

Beth Israel Lahey Health; Cambridge (MA); On-site; USD 30,000 - 41,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Denial Specialist to identify, review, and interpret third-party payments, adjustments, and denials. You will initiate corrected claims, appeals, and analyze unresolved accounts, collaborating with the Billing Supervisor to resolve complex issues through independent research and assigned projects.

The role requires 2–3 years in healthcare denials, a High School diploma, and knowledge of payor reimbursement, eligibility verification, and regulatory rules.

Qualifications

• High School diploma required.
• Billing Certification preferred.
• 2–3 years of experience in healthcare denials.
• Working knowledge of third-party payor reimbursement, eligibility verification process, and government and payor compliance rules.

Responsibilities

• Monitors days in A/R and ensures levels meet management expectations.
• Navigate hospital billing system to identify paid claims or root causes of denial.
• Respond to insurance/office calls and resolve issues affecting current or potential claims.
• Establish relationships with third-party payor representatives to resolve claims issues.
• Review CMS 1500 fields for accuracy and correct denials/edits; initiate rebilling or appeals.
• Evaluate delinquent third-party accounts and determine payment plans or write-offs.
• Update accounts for write-offs and refunds; manage insurance credit balances.

Skills

Payor Reimbursement

Eligibility verification

Payor compliance

Education

High School diploma

Job description

Beth Israel Lahey Health is seeking a Denial Specialist to identify, review, and interpret third-party payments, adjustments, and denials. You will initiate corrected claims, appeals, and analyze unresolved accounts, collaborating with the Billing Supervisor to resolve complex issues through independent research and assigned projects.

The role requires 2–3 years in healthcare denials, a High School diploma, and knowledge of payor reimbursement, eligibility verification, and regulatory rules.