Denials and Appeals Analyst

Brigham and Women's Hospital • Somerville, MA

110d • Hybrid

About The Position

Under the general guidance of the Patient Access Services Denial Manager, the Admitting Department Appeals Specialist is responsible for assisting with insurance denials and is expected to adhere to programs, policies, and procedures to maximize reimbursement by minimizing denials. Under the supervision of the Patient Access Manager, the Appeals Specialist also monitors Huron and EPIC reports and work queues to ensure timely response to denied cases, prepares and submits appeals, and provides follow-up on cases until resolution has been achieved. Reviews appealed cases to assist in the determination of departmental write-offs, as appropriate. Cultivates, maintains, and enhances relationships with third-party payors. The analyst performs all these functions in a manner that complies with standards established by the Hospital Administration, Medical Staff, and outside regulatory and accreditation agencies. Works toward goals and objectives for departmental denial management.

Requirements

• High School diploma/GED required.
• Bachelor's degree in business, accounting, or healthcare-related field preferred.
• Minimum of 2-4 years in a health care setting with administrative and financial work experience.
• Denials or appeals experience required.
• Effective, results-oriented skills.
• Interpersonal skills to interact effectively with all levels of staff, management, and leadership.
• Ability to collaborate in an effective interdisciplinary team approach.
• Superior problem-solving skills and ability to manage multiple demands and priorities.
• Independent judgment to deviate from standard policies and procedures when necessary.
• Excellent communication skills both oral and written.
• Sound analytical skills.
• Knowledge of computers and management information systems.
• Strong computer skills and understanding to efficiently data mine denial data and presentation skills (e.g. Excel, Word, PowerPoint).
• Ability to adapt to changes in the workspace.
• Ability to work well in a demanding and changing environment.
• Assist with training of new employees when necessary.

Responsibilities

• Assist with insurance denials and adhere to programs, policies, and procedures to maximize reimbursement.
• Monitor Huron and EPIC reports and work queues for timely response to denied cases.
• Prepare and submit appeals, providing follow-up on cases until resolution.
• Review appealed cases to assist in determining departmental write-offs.
• Cultivate and maintain relationships with third-party payors.
• Ensure compliance with standards established by Hospital Administration and regulatory agencies.
• Work towards goals and objectives for departmental denial management.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees