Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
SummaryThe role is responsible for ensuring the highest quality of work via daily management of EPIC WQs and reporting, writing appeals, monitoring, analysis, and collaboration with department subject matter experts. This position works within the hospital system's revenue cycle operations, specializing in the resolution and prevention of prior authorization denials across high-dollar, high-risk service lines. This role focuses on elective surgical cases, complex outpatient procedures, infusion therapies, and emergent/urgent admissions. The position leverages clinical documentation, payer policy expertise, and cross-functional collaboration to drive financial recovery, reduce denial rates, reduce write-offs, and improve authorization workflows. This position also assists in the development, implementation, and monitoring of new and existing qualitative and quantitative key performance indicators (KPI) for the Denials team and works with departments to develop the appropriate processes, monitoring controls, and reporting. The role will also develop and update policies and procedures in these areas for reference materials and new hire onboarding. The position compiles and summarizes information, presenting results to Patient Access leadership, Revenue Cycle Operations, and other MGB Departments as needed.
Does this position require Patient Care?
No
Essential Functions
-Performs advanced data mining from Slicer /Dicer (Revenue, denials, write-offs) and other data analytic tools to identify denial and write-off trends and works with Revenue Operations, Practices, and Prior Authorization teams to create daily, weekly, or monthly reports as needed.
-Performs root cause analysis and trend reporting to identify systemic issues and payer-specific denial patterns, and analyzes denial and write-off trends; presents monthly reports to Practices and Revenue Operations with actionable insights and recommendations for prevention.
-Collaborates and serves as liaison with coding, clinical, registration, Prior Authorization, Revenue Operations, and Practice teams to resolve and address systemic issues contributing to claim denials.
-Independently drafts nuanced appeals citing clinical documentation, payer policy, and coding guidelines; identifies and resolves retro authorization gaps across service lines.
-Monitors compliance with all organizational policies, regulatory standards, and documentation protocols; identifies QA opportunities for Prior Authorization and Practice teams, and monitors KPIs such as appeal success rates, denial overturn percentages, retro authorizations, and revenue recovery.
-Prepares and presents detailed reports on denial statistics and QA findings to management, highlighting areas for improvement.
-Trains and mentors staff on best practices for preventing denials, providing guidance and training to analysts on appeal strategy, write-offs, root cause analysis, documentation standards, and payer compliance, while fostering team development.
-Assists in the development of enhancements to existing systems related to Denials /Write-offs, Revenue Operations, and Quality Assurance.
-Recommends process improvements based on data analysis and industry best practices to enhance overall operational effectiveness, such as the development of reusable appeal templates, the use of artificial intelligence, retro-auth reporting, and troubleshooting guides to streamline team operations and reduce rework.
Qualifications
Additional Job Details (if applicable)
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$78,000.00 - $113,453.60/AnnualGrade
7At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
EEO Statement:
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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What We Do
Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization that is committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School.
