Lahey Health PFS Denial Specialist II in Burlington, Massachusetts


Position Summary:

The PFS Denial Specialist II role is vital to ensure that hospital denied accounts are thoroughly reviewed for any opportunity to correct, refile and or appeal claims for re-processing and reimbursement. The role also includes review and rework of all coding and charge related denials, as well as analysis and education to reduce denials and increase hospital reimbursement.

Essential Duties & Responsibilities including but not limited to:

  • Reviews and completes continuous daily work queue volume of Coding and Charge Related Denials.

  • Proactively identifies problems or opportunities for improvements related to orders and/or documentation and makes recommendations to Manager and/or the perspective departments with high volume/high dollar values.

  • Utilize CAC or other electronic coder assisting tools available to validate proper coding of CPT/HCPCS/ICD-9/ICD-10 codes.

  • Assists in the development of reporting mechanisms to identify trends and track so that education can be performed to reduce and/or resolve high dollar/high volume values.

  • Develop strong working relationships with other Lahey Health department personnel to promote clear communication and welcomed education for reimbursement enhancement.

  • Keeps abreast of all government and payor level hospital coding, billing and reimbursement rules, regulations and guidelines

  • Promotes Teamwork and maintains a positive atmosphere when communicating with fellow departmental colleagues both oral and written.

Organizational Requirements:

Maintain strict adherence to the Lahey Hospital and Medical Center Confidentiality policy.

Incorporate Lahey Hospital and Medical Center Standards of Behavior and Guiding Principles into daily activities

Comply with all Lahey Hospital and Medical Center Policies.

Comply with behavioral expectations of the department and Lahey Hospital and Medical Center.

Maintain courteous and effective interactions with colleagues and patients.

Demonstrate an understanding of the job description, performance expectations, and competency assessment.

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

Participate in departmental and/or interdepartmental quality improvement activities.

Participate in and successfully completes Mandatory Education.

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


Minimum Qualifications:


High School Diploma or equivalent.

Bachelor?s degree or 4 years? experience in a hospital billing/coding, Denial Management environment related field.

Must have experience in either a hospital related billing, claims follow up environment or hospital coding.

Licensure, Certification & Registration:

Experience: Experience using patient accounting computer systems and Excel spreadsheets. Working knowledge of third party payer reimbursement, coding guidelines, and government and payer compliance rules



About Lahey Health

The Lahey Model of Care - right care, right time, right place - is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.

Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.

How To Apply

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Lahey Health


Lahey Health is committed to equal opportunity. We recruit, hire, train and promote without discrimination due to race, color, religion, gender, sexual orientation, national origin, ancestry, marital status, age, disability, citizenship, veteran status, or any other protected job status. Lahey Clinic provides equal employment opportunities to minorities, females, veterans, and disabled individuals, as well as other protected groups. Please click here to view the "EEO is the Law" poster.