Remote Clinical Appeals Analyst - Coding & Compliance

Beth Israel Lahey Health; Boston (MA); On-site; USD 93,142 - 124,800; Full time

Job summary

Beth Israel Lahey Health is seeking a Clinical Analyst to join the Patient Financial Services team and lead complex clinical appeals, audits, and compliance initiatives across inpatient and outpatient settings. You will ensure medical necessity and appropriate level of care, review coding and documentation, and educate providers on billing rules and policies.

You will analyze denial trends, prepare appeals, participate in payer negotiations, and help develop training materials to improve

Qualifications

• Associate degree preferred in business, healthcare, or finance.
• 2–3 years auditing with CPT/HCPCS/DRG coding experience.
• Experience with healthcare revenue cycle processes and documentation.

Responsibilities

• Maintain reporting on clinical appeals, audits, and compliance.
• Support denial initiatives and manage payer audit results.
• Prepare and defend appeals for denials and adverse audit outcomes.
• Educate providers on coding, billing, and documentation requirements.
• Identify trends and provide recommendations to Revenue Cycle Leadership.

Skills

CPT coding

ICD-10 knowledge

Auditing

Revenue cycle

Excel

Communication

Education

Associate degree in business/healthcare/finance

Tools

Epic Resolute HB

MS Office

Job description

Beth Israel Lahey Health is seeking a Clinical Analyst to join the Patient Financial Services team and lead complex clinical appeals, audits, and compliance initiatives across inpatient and outpatient settings. You will ensure medical necessity and appropriate level of care, review coding and documentation, and educate providers on billing rules and policies.

You will analyze denial trends, prepare appeals, participate in payer negotiations, and help develop training materials to improve