Denials and Appeals Analyst
Denials and Appeals Analyst
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1 Vacancy
Job Description
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
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.Qualifications
High School diploma/GED required.
Bachelors 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.
Skills/Abilities/Competencies:
Requires effective results-oriented skills.
Requires interpersonal skills to interact effectively with all levels of staff management and leadership.
Must be able to collaborate in an effective interdisciplinary team approach.
Requires superior problem-solving skills and the ability to work with multiple demands and priorities.
Requires independent judgment to deviate from standard policies procedures and schedules when necessary.
Requires excellent communication skills both oral and written. - Requires sound analytical skills.
Requires knowledge of computers and management information systems and the ability to provide specifications for program development system enhancements and reports.
Requires strong computer skills and understanding to efficiently data mine denial data and presentation skills (e.g. Excel Word) Powerpoint).
Due to the volume of denials and complexity in analysis the pace of work is hectic and challenging the workload could necessitate working off hours.
Must be able 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.
The key to the institutions financial viability lies in the integrity of the data collected. The work performed by the Admitting Appeals Specialist is a cornerstone of the institutions reimbursement. This position plays a crucial role in preventing denials through root cause analysis and writing appeals as well as assisting with retro-authorizations and analysis.
Hybrid Working Model:
This position is hybrid requiring onsite presence at least 1 day per week at Assembly Row in Somerville MA.
Additional Job Details (if applicable)
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
IC
Employment Type
Full-Time
