Revenue Cycle Operations Specialist Denials & Billing

Beth Israel Lahey Health; Boston (MA); On-site; USD 33,000 - 45,000; Full time

Job summary

Beth Israel Lahey Health in Boston is seeking a Revenue Cycle Operations Specialist to manage a broad range of medical billing tasks, focusing on registration, coverage, and eligibility for Professional and Hospital Billing. You will resolve payor edits and denials and support process improvements.

The role requires strong knowledge of payer rules, Epic Resolute proficiency, and at least 3 years of billing/denial management experience in a healthcare setting.

Qualifications

• Strong knowledge of third-party payor reimbursement processes and denial management.
• Experience with eligibility verification and government payor rules.
• Familiarity with Epic Resolute Professional/Hospital Billing is a plus.

Responsibilities

• Identifies, researches, and resolves professional and hospital billing issues for commercial and government payors.
• Reviews registration, coverage, and eligibility related front-end edits and denials to ensure accurate billing.
• Posts manual adjustments when appropriate and escalates complex issues for review.
• Attends monthly conference calls with physician groups to provide operational billing support and training.
• Collaborates with departments and vendors to resolve registration and billing questions.
• Performs root-cause analyses to identify improper billing trends and opportunities for improvement.

Skills

Third-party payor reimbursement

Eligibility verification process

Government and payor compliance rules

Education

Associate degree or equivalent experience

Job description

Beth Israel Lahey Health in Boston is seeking a Revenue Cycle Operations Specialist to manage a broad range of medical billing tasks, focusing on registration, coverage, and eligibility for Professional and Hospital Billing. You will resolve payor edits and denials and support process improvements.

The role requires strong knowledge of payer rules, Epic Resolute proficiency, and at least 3 years of billing/denial management experience in a healthcare setting.