Lahey Health PFS Denial Specialist II in Burlington, Massachusetts

Welcome To

Lahey Health Shared Servicesis a vibrant and growing health care system, recognized as a trailblazer in medicine and a standard bearer in patient experience. It includes an award-winning academic medical center, a superb constellation of community hospitals, home care services, rehabilitation facilities and more.

We are committed to attracting, developing and retaining top talent in a market long recognized and revered as a global leader in health. With a team approach to care, we encourage learning and growth at all levels, and we offer competitive salaries and benefits. We adhere to the principles of ajust and fair work environment for all colleagues, where respect is foundational and performance is rewarded.

About the Job

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.

  • 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.

About Us

Lahey Health Shared Services (LHSS) provides unified and streamlined administrative and operational services and support to all members of the Lahey Health system.

Through use of best practices, LHSS achieves greater efficiency and effectiveness across Lahey Health, helping create the most effective organization possible, for both our patients and our employees. LHSS is dedicated to leveraging resources across the organization to ensure high-quality, high-value care to the people and communities we care for so proudly.

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