Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Under the general direction of the Admissions Supervisor, Manager, and Director, is responsible for managing insurance denials for Lahey Clinic Patient Access Services. Assists department managers with establishing programs, policies and procedures to maximize reimbursement by minimizing denials.

Job Description:

Essential Duties & Responsibilities including but not limited to:

1. Monitors denial database to ensure timely response to denied cases; prepares and submits appeals, provides follow-up on cases until resolution has been achieved. Initiates departmental write-off policy, as appropriate

2. Cultivates, maintains and enhances relationships with third party payers; maintains a strong knowledge base of all payers’ processes, guidelines and requirements and of all payers’ system limitations.

3. Ensures completion of all daily operational functions in Admissions work areas by monitoring for unfinished work.

4. Oversees all Inpatient, Observation and Surgical day care denials.

5. Contacts, investigates and resolves SDC, OBS and INP denials.

6. Dictates appeal letters in a timely manner.

7. Communicates closely with appropriate departments in order to resolve any outstanding denial issue.

8. Works with department leadership team to identify opportunities for improved operational functions and processes.

9. Takes daily assignments in any operational area as needed, performing operational responsibilities including, including interviewing patients to obtain demographic, employment, insurance and financial information; obtaining

ICD9 and CPT codes for all admissions, obtaining prior approval for all E.D. visits and/or future procedures and entering this information into the Lahey clinic Medical Center data base and if/when applicable, use of the

available insurance verification tools to obtain verification of the insurance coverage; scheduling preoperative consults and/or tests, checking patients in on the surgical and preoperative reservation list, monitoring and controlling bed assignments, preparing admission/registration forms, and performing other clerical duties related to

admission/registration, discharge, and transfers.

10. Takes daily responsibility for observing process areas, identifying backlogged work functions and taking or recommending corrective actions

11. Completes daily monitors to ensure integrity of departmental work output.

12. Monitors departmental areas to assure rapid customer response and ensure efficient patient flow.

13. Incorporates Lahey Clinic Guiding Principles, Mission Statement and Goals into daily activities.

14. Complies with all Lahey Clinic Policies.

15. Complies with behavioral and dress expectations of the department and Lahey Clinic.

16. Maintains courteous and effective interactions with colleagues and patients.

17. Demonstrates an understanding of the job description, performance expectations, competency assessment, and departmental goals and expectations

18. Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.

19. Participates in departmental and/or interdepartmental quality improvement activities.

20. Participates in and successfully completes required Lahey Clinic and position specific educational programs

21. Performs all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:

Education: Associates degree or equivalent work experience
Licensure, Certification, Registration:

Skills, Knowledge & Abilities: Working knowledge of Meditech, IDX, PICIS, LCMC, and Documentum systems, as well as of ICD9 and CPT coding. Proven ability to work well with peers and customers.

Experience: Knowledge of all hospital admissions task functions, including insurance-specific on-line verification/pre-certification systems, usually acquired through a minimum of one year of experience in a hospital admissions department.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled