Benjamin Cohen
West Roxbury,MA
Overview
13
13
years of professional experience
Work History
PFS Specialist - Government team
Beth Israel Lahey Health
Boston, MA
01.2021 - 01.2026
- Resolved Medicare issues and denials to ensure timely reimbursement.
- Executed appeals for outpatient claims to Medicare, improving approval rates.
- Worked all outpatient Medicare claims.
- Worked Medicare Managed and Point 32 claims for all hospitals under the BILH umbrella
- Worked both Inpatient and Outpatient claims.
- Epic superuser who completed extra training and trained the team on how to use EPIC.
- Contributed to PECOS/credentialing project to enhance provider enrollment processes.
- Processed IME claims to ensure accurate handling and compliance.
- Worked with HIM and Revenue Integrity teams to ensure claims are coded and billed correctly.
Denials Coordinator
Newton-Wellesley Hospital
Newton, MA
01.2019 - 01.2021
- Handled all authorization-related denials for Newton-Wellesley Hospital.
- Worked with physicians and case management on medical necessity denials.
- Collaborated with central authorization team to educate on processes and reduce future authorization denials.
- Experience using Epic to research and work patient claim denials.
- Analyzed and reported denial trends to inform strategies for preventing future occurrences.
- Managed multiple Huron worklists to mitigate revenue loss from denials.
- Utilized coding skills to accurately process medical claims. and Applied ICD-10 codes for accurate billing and reimbursement..
Accounts Receivable Representative
Radnet, Incorporated
Owings Mills, MD
01.2013 - 01.2019
- Specialized in insurance follow up and denial management of government and private payers such as Blue Cross Blue Shield, Medicare, Medicaid, etc. in accordance with HIPAA regulation and PHI policies and protocol.
- Reviewed remittance for paid and denied insurance claims to resolve aged accounts, appealing to align with company revenue goals and industry DSO standards.
- Corrected claims failing in Availity clearing-house to ensure clean, accurate electronic claims submission.
- Evaluated EMR for modifiers, diagnosis codes, and CPT codes in accordance with medical necessity and coding.
- Possess a strong understanding of medical terminology and payer protocol within the radiology and cardiovascular specialty.
- Diagnosed a regional account clientele ranging from nine practices including Advanced Radiology Services, American Radiology Services, Korsower and Pion, Community Radiology Associates, The Imaging Institute of Rhode Island, Clinical Radiology Associates, Radiology Associates of New Jersey, The Borg and Ide Radiology, and Hudson Valley Radiology.
- Coordinated with attorneys to process legal claims efficiently.
Education
High School Diploma -
Franklin High School
Reisterstown, MD01-2005
Skills
- Medicare billing
- ICD-10 coding
- Denial appeals
- Claims adjudication
- Insurance follow up
- Payer policy
- Revenue cycle
- Epic claim management
- EMR program management
- HIPAA compliance
- Analytical thinking
- Attention to detail
- Cross functional communication
- Team collaboration
- Team collaboration
Timeline
PFS Specialist - Government team
Beth Israel Lahey Health
01.2021 - 01.2026
Denials Coordinator
Newton-Wellesley Hospital
01.2019 - 01.2021
Accounts Receivable Representative
Radnet, Incorporated
01.2013 - 01.2019
High School Diploma -
Franklin High School