Clinical Analyst – Appeals

Beth Israel Lahey Health

Clinical Analyst managing clinical appeals and audit processes for patient financial services. Ensuring compliance with billing, coding, and documentation requirements at Beth Israel Lahey Health.

Posted 6/11/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $93,142 - $124,800 per yearWebsite

ATS Keywords

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Hard Skills

auditingdenial managementCPT codingHCPCS codingDRG codingclinical documentationcompliance analysisreportingtrend analysisprocess review

Soft Skills

problem identificationcommunicationorganizational skillscollaborationattention to detailanalytical thinkingrecommendation developmentproject supportpolicy enforcementproactive approach

Tools & Technologies

denial reporting toolsEpic Resolute HB

Certifications & Qualifications

RNLPNCPCRTMTRPH

Industry Keywords

healthcare revenue cycleclinical appealsauditscompliancepayer auditclaims denialsBILH policiesutilization reviewclinical ordershealthcare finance

About the role

Key responsibilities & impact

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.
Perform process review of denials by hospital departments,
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.
Analyzes work queues and other system reports identifies denial/non-payment trends, and reports and provides recommendations to the Revenue Cycle Leadership.
Proactively identifies problems or opportunities for improvements related to clinical orders and/or clinical documentation.

Requirements

What you’ll need

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.
Applicable clinical or professional certifications/licenses such as RN, LPN, CPC, RT, MT, and RPH are highly desirable.
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

Benefits

Comp & perks

Health insurance
401(k) matching
Paid time off
Professional development opportunities