Top 160 Rn/quality analyst Jobs in Boston, Ma

Clinical Analyst Appeals (Remote)
Beth Israel Lahey Health —Charlestown, MA
- $93,142 - $124,800 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
Senior Nurse Reviewer
Mass General Brigham Incorporated —Somerville, MA
- $79,560.00 - $115,720.80 a year
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
- Opportunities for advancement
Quick Apply
RN Case Review Coordinator - Per Diem - Faulkner
Brigham and Women's Faulkner Hospital, Inc. —Boston, MA
- $41.36 - $100.00 an hour
- Part-time
- Hybrid work
- Nursing
- RN License
- 5 years
- Opportunities for advancement
Quick Apply
5d
RN Case Review Coordinator - Faulkner
Brigham and Women's Faulkner Hospital, Inc. —Boston, MA
- $41.36 - $100.00 an hour
- Full-time
- Nursing
- RN License
- 5 years
- Opportunities for advancement
Quick Apply
Virtual RN, Home Hospital
Mass General Brigham Home Care, Inc. —Somerville, MA
- $40.09 - $78.04 an hour
- Part-time
- Nursing
- Microsoft Outlook
- RN License
- Opportunities for advancement
Quick Apply
Per Diem RN - Oncology Practice - MGH
The General Hospital Corporation —Danvers, MA
- $41.72 - $105.65 an hour
- Part-time
- Nursing
- RN License
- Hospital
- Opportunities for advancement
Quick Apply
RN Case Manager - Medicine - MGH
The General Hospital Corporation —Boston, MA
- $41.72 - $105.65 an hour
- 8 hour shift
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Med/Surg Staff Nurse
The Brigham and Women's Hospital, Inc. —Boston, MA
- $41.71 - $105.65 an hour
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Opportunities for advancement
Quick Apply
8d
RN, Cardiac Arrhythmia Stepdown Unit - MGH
The General Hospital Corporation —Boston, MA
- $41.72 - $105.65 an hour
- 12 hour shift
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
10d
Inpatient Clinical Documentation Integrity Risk Adjustment Specialist
Mass General Brigham Incorporated —Somerville, MA
- $79,560.00 - $115,720.80 a year
- Full-time
- Remote
- RN License
- Research
- 3 years
- Opportunities for advancement
Quick Apply
CBHI Behavioral Health Utilization Manager (Outpatient and Non-24 Hour Diversionary Services)
WellSense Health Plan —Boston, MA
- $69,500 - $100,500 a year
- Full-time
- LMFT
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance
Neuroscience Intermediate Unit Staff Nurse
The Brigham and Women's Hospital, Inc. —Boston, MA
- $41.71 - $105.65 an hour
- Part-time
- Nursing
- RN License
- Bachelor of Science
- Opportunities for advancement
Quick Apply
5d
Experience RN Per Diem 4 East
Brigham and Women's Faulkner Hospital, Inc. —Boston, MA
- $41.36 - $100.00 an hour
- Part-time
- Nursing
- RN License
- BLS Certification
- Opportunities for advancement
Quick Apply
3d
Program Integrity Clinical Compliance Auditor
Optum —Boston, MA
- $29 - $52 an hour
- 8 hour shift
- Remote
- 18 years or older
- RN License
- Customer service
- On-the-job training
RN Endoscopy
North Shore Medical Center, Inc. —Salem, MA
- $39.27 - $94.69 an hour
- Part-time
- Nursing
- RN License
- Hospital
- Opportunities for advancement
Quick Apply
RN IV
North Shore Medical Center, Inc. —Salem, MA
- $39.27 - $94.69 an hour
- 8 hour shift
- Nursing
- RN License
- Hospital
- Opportunities for advancement
Quick Apply
Vascular Access Team Nurse BWH
The Brigham and Women's Hospital, Inc. —Boston, MA
- $41.71 - $105.65 an hour
- Part-time
- Nursing
- RN License
- Bachelor of Science
- Opportunities for advancement
Quick Apply
Stepdown Medicine Float Pool Nurse BWH
The Brigham and Women's Hospital, Inc. —Boston, MA
- $41.71 - $105.65 an hour
- Full-time
- Nursing
- Float pool
- RN License
- Opportunities for advancement
Quick Apply
8d
Quality Nurse Program Manager
Newton-Wellesley Hospital —Newton, MA
- $77,584.00 - $150,321.60 a year
- Full-time
- Nursing
- RN License
- Hospital
- Opportunities for advancement
Quick Apply
RN Navigator - Pre/Post Surgical Optimization
Mass General Brigham Community Physicians, Inc. —Somerville, MA
- $58,656.00 - $142,448.80 a year
- Full-time
- Hybrid work
- Acute care
- Nursing
- Surgery
- Opportunities for advancement
Quick Apply
11d

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rn/quality analyst jobs near boston, ma

Clinical Analyst Appeals (Remote)

Beth Israel Lahey Health -
Charlestown, MA

Apply Now

Job Details

Full-time
$93,142 - $124,800 a year

Qualifications

Microsoft Excel
Microsoft Outlook
Process audits
Medicare
Healthcare documentation compliance audits
Windows
Medicare regulations
Centers for Medicare and Medicaid Services (CMS)
Centers for Medicare & Medicaid Services (CMS) billing regulations
Insurance claims auditing
Clinical documentation standards
Healthcare claims compliance audits
Data analysis software

Full Job Description

Charlestown, MA • Beth Israel Lahey Health • Full-time • Day

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

Reporting to the Manager, Patient Financial Services, the Clinical Analyst plays an important role in a high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will perform high-level clinical appeal for services in the inpatient and outpatient hospital setting, to ensure that Beth Israel Lahey Health (BILH) is in compliance with all applicable federal and state laws and regulations as they pertain to coding, billing, and documentation.

To educate, give support, and provide guidance to all BILH providers about compliance, billing, coding, and documentation requirements. To perform and monitor Third Party Payer audits by obtaining information relative to all claims audited with regards to policies, departmental practices/processes, and procedures; to gather information that would support submitted charges. Prepare clinical appeals relevant to the audits in order to prove medical necessity and level of care were warranted in these cases.

Job Description:

Essential Duties & Responsibilities including but not limited to:

Maintain a system of reporting that provides timely and relevant information on all aspects of clinical appeals, audits, and compliance issues to management.
Participates in complex projects related to denial initiatives. Provides support for projects in which senior managers are involved.
Assist in the tracking and review of payer audit and denial results. Prepare appeal requests as appropriate.
Responsible for appealing and defending claims denials, adverse audit results, and sanctions.
Analysis, tracking, and trend of daily, weekly, and monthly denials by payer using denial reporting tools. Maintain a system of reporting that provides timely and relevant information on all aspects of clinical appeals, audits, and compliance issues to Revenue Cycle Leadership.
Perform process review of denials by hospital departments, and provide clinical improvement initiatives.
Draft, revise, and enforce BILH policies and procedures as they apply to appeal and audit functions.
Conduct regular audits to ensure that BILH is coding, billing, and documenting completely and accurately and is in compliance with all applicable federal and state laws and regulations.
Analyzes work queues and other system reports identifies denial/non-payment trends, and reports and provides recommendations to the Revenue Cycle Leadership.
Perform sensitive and complex investigations into allegations of billing fraud or abuse, as necessary.
Appeal and defend claims denials, adverse audit results, and sanctions.
Proactively identifies problems or opportunities for improvements related to clinical orders and/or clinical documentation and makes recommendations to management and/or the perspective departments with high volume/high dollar values.
Representation at scheduled meetings with assigned payers and provider representatives to address all outstanding claims processing issues. Maintain an ongoing issues tracker for each payer in order to communicate and trend all issues and communicate with contracting any and all contracting-related problems.
Communicate appeal results to the Manager, Director of Patient Accounts, and VP of Revenue Cycle.
Assist in the development of coding, billing, and documentation training and educational materials and perform the training throughout BILH, as necessary.
Assist with review of HCAC/PCC charge identification.

Organizational Requirements:

Maintain strict adherence to the Beth Israel Lahey Health Confidentiality policy.
Incorporate Beth Israel Lahey Health Standards of Behavior and Guiding Principles into daily activities.
Comply with all Beth Israel Lahey Health Policies.
Comply with the behavioral expectations of the department and Beth Israel Lahey Health.
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 adhere to Customer Service standards.
Participate in departmental and/or interdepartmental quality improvement activities.
Participate in and successfully complete Mandatory Education.
Perform all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:
Education:

Associate degree preferably in the business, healthcare, or finance field
In the absence of an Associate’s Degree, an additional 4 years of healthcare revenue cycle experience are required.

Licensure, Certification & Registration: Applicable clinical or professional certifications/licenses such as RN, LPN, CPC, RT, MT, and RPH are highly desirable.
Experience:

Minimum of two (2) to three (3) years auditing and familiarity with CPT/HCPCs/DRG coding experience required.
Clinical education and/or utilization review experience is strongly preferred.
Requires minimum 2 years of healthcare revenue cycle experience
Epic Resolute HB desired

Skills, Knowledge & Abilities:

Must have sound understanding of ICD-10, and CPT coding systems; prospective reimbursement system.
Ability to review and analyze issues related to coding, billing, and medical record documentation.
Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including administrative and management staff.
Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook, Excel, and Access.
Possess effective oral and written skills, including superb formal presentation skills.
Well-developed research skills.
Excellent organizational and project management skills.
Possess effective time management skills to permit handling of large workloads.
A thorough understanding and knowledge of Medicare rules and regulations is required.
Experience with medical chart review; an understanding of billing issues and reimbursement; and extensive knowledge of ICD-10, and CPT coding.
Ability to read, analyze, and interpret financial reports.
Ability to define problems, collect data, establish facts, draw conclusions, and make sound recommendations.
Capacity to analyze and think creatively and weigh alternatives.
Perception of people and an awareness to deal with conflict successfully and attain resolution
Demonstrates attention to detail.
Demonstrates excellent organizational skills.
Demonstrates skills in multitasking

Pay Range:

$93,142.00 USD – $124,800.00 USD

The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.

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) as a condition of employment.

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

Job details

Employment: Full-time
Hours/Week: 40
Shift: Day
Category: Billing, Collections, & Patient Financial Services
Pay Range: $93,142.00 USD - $124,800.00 USD
FLSA: Exempt
Req ID: JR94494

Apply Now

Refine Your Search

rn/quality analyst jobs in boston, ma

Clinical Analyst Appeals (Remote)

Senior Nurse Reviewer

RN Case Review Coordinator - Per Diem - Faulkner

RN Case Review Coordinator - Faulkner

Virtual RN, Home Hospital

Per Diem RN - Oncology Practice - MGH

RN Case Manager - Medicine - MGH

Med/Surg Staff Nurse

RN, Cardiac Arrhythmia Stepdown Unit - MGH

Inpatient Clinical Documentation Integrity Risk Adjustment Specialist

CBHI Behavioral Health Utilization Manager (Outpatient and Non-24 Hour Diversionary Services)

Neuroscience Intermediate Unit Staff Nurse

Experience RN Per Diem 4 East

Program Integrity Clinical Compliance Auditor

RN Endoscopy

RN IV

Vascular Access Team Nurse BWH

Stepdown Medicine Float Pool Nurse BWH

Quality Nurse Program Manager

RN Navigator - Pre/Post Surgical Optimization

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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) as a condition of employment.

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

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