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Revenue Cycle Denial Analyst

Department Description: Position supports our revenue cycle department and is located at 1135 Tremont St.

Job Location: Boston, MA

Req ID: 37473BR

Job Summary: The Revenue Cycle Denial Analyst is charged with coordinating the analysis and effective resolution of denied claims with the purpose of reducing overall denials and increasing revenue. This includes interpreting payment and denial data down to the line item detail, identifying payer and coding trends, risks, and opportunities, to implement operational or systematic improvements. Essential to this position are strong quantitative, analytical and organizational skills. Excellent communication and interpersonal skills with the ability to effectively interpret, communicate, and educate others.

Essential Responsibilities:
  1. Responsible for prioritizing and managing to resolution denied claims with third party payers. Research, develop and maintain a solid understanding of payer requirements, including filing limit, claim processing logic, coordination of benefits requirements, patient responsibility and authorization requirements.
  2. Ability to triage denied claims to identify those that should be appealed. Responsible for writing timely, comprehensive and compelling appeals to third party payers in order to get denial overturned. Responsible for timely follow up on filed appeals via telephone, writing, or the payer website.
  3. Organizes, maintains and updates the access payer database to house the issues that need to be addressed with third party insurers, as well as maintaining an expert knowledge of the history of prior disputes and problems to prevent them from recurrence. Applies findings to internal systems and workflows such as pre-billing edits and system automation.
  4. Performs ongoing analysis to determine the root cause of denials and makes well thought out recommendations for workflow, operations or systemic changes. Maintains action plans for improvements.
  5. Compiles, maintains and distributes reports to management on success of appeals and root cause analysis. Serves as department resource related to denials and payer requirements.
Required Qualifications:
  1. High School diploma or GED required. Bachelor's degree preferred.
  2. 1-3 years related work experience required.
  3. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
Preferred Qualifications:
  1. 3 -5 years Healthcare related experience.
  1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
  2. Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.
  3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
  4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
  5. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
  6. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
  7. Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
  8. Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally

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