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. Initiates corrected claims, appeals, and analyzes unresolved third-party and self-pay accounts, initiating contacts and negotiating appropriate resolution to ensure timely and maximum payment.

You will work with the Billing Supervisor, navigate Epic, respond to inquiries, and pursue denial reductions through audits, rebilling, and appeals.

Qualifications

• Two to three years of healthcare denial experience.
• Knowledge of third-party payer reimbursement and eligibility checks.
• Familiarity with payer regulations and compliance rules.

Responsibilities

• Monitor days in A/R and keep levels as directed by management.
• Identify denial trends and report to Billing Supervisor.
• Navigate the hospital billing system to find root causes of denials.
• Respond to calls professionally and resolve insurance issues.
• Maintain relationships with third-party payor representatives.
• Review CMS 1500 fields for accuracy and documentations.
• Initiate rebilling, appeals, or corrections as needed.
• Evaluate delinquent accounts for payment plans or write-offs.
• Review write-offs and refunds; ensure proper posting.
• Keep up with federal/state contracts and billing rules.

Skills

Third-party payor reimbursement

Eligibility verification

Payor compliance rules

Education

High School diploma

Billing Certification preferred

Tools

Epic

Job description

Beth Israel Lahey Health is seeking a Denial Specialist to 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 to ensure timely and maximum payment.

You will work with the Billing Supervisor, navigate Epic, respond to inquiries, and pursue denial reductions through audits, rebilling, and appeals.