Denials and Appeals Analyst

Brigham and Women's Hospital
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Mar 05, 2025
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. High School diploma/GED required. Bachelor's 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. 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 institution's financial viability lies in the integrity of the data collected. The work performed by the Admitting Appeals Specialist is a cornerstone of the institution's 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. The Brigham and Women's Hospital, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.