Denial Prevention Analyst at Mary Free Bed Rehabilitation Hospital – Grand Rapids, Michigan

Summary

Responsible for performing analysis to identify denials, appeals and correction actions to optimize reimbursement. Analyst will leverage the interpretation of payer contracts as well as state and federal regulatory guidelines. These efforts will result in increased net revenues by reducing bad debt from potential write-offs due to lack of patient collections and denials.

Essential Job Responsibilities

• Reviews explanation of benefits and benefits coverage to determine the best course of action. If needed for further clarification, contact insurance carrier
• Analyzes denial trends for staff/organizational education purposes
• Research online medical bulletins and policies, pricing and contractual issues
• Reviews clinical documentation, coding and claim to determine if the times and services provided to patients were applied correctly
• Prepares and mails written rationale of claim reconsideration request
• Tracks all denials within a database for reporting
• Maintains appropriate established timelines for follow up on outstanding appeal/reconsideration requests
• Collaborates with other Revenue Cycle Management and clinical departments to resolve claim issues as needed
• Any other duties as assigned

• Embrace Diversity, Equity and Inclusion, by:

Treating everyone with dignity and respect

Opening more doors to opportunities for underrepresented cultures

Growing talent and people

Evaluating and eliminating disparities

Taking action against injustices, bias and racism

Honoring our differences and how to collaborate

Educating staff, patients and the communities we care for

Restoring Hope and Freedom, together

Customer Service Responsibilities

Demonstrate excellent customer service and standards of behaviors as well as encourages, coaches, and monitors the same in team members. This individual should consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information.

Responsibilities in Quality Improvement

Contribute by identifying problems and seeking solutions. Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.

Essential Job Qualifications

• Associates Degree and a minimum of 3 years’ experience in healthcare denial prevention. Knowledge of payer benefit policies and utilization review experience.
• Possesses a high level of initiative, self-directed, highly motivated and analytically minded
• Comprehension of healthcare terminology
• Time management skills to handle multiple, competing demands and priorities, and work effectively under pressure
• Strong, effective organization and interpersonal skills
• Superior written communication skills, including ability to write well organized, concise payer appeals
• Collaborative team style and open communication, including with other departments
• Excellent analysis and problem solving skills
• Demonstrated commitment to organizational mission with a “whatever it takes” attitude to get the job done
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)
• Excellent computer knowledge and use of appropriate Electronic Medical Records, Admissions, and Utilization Management applications

Preferred Job Qualifications

• IRF medical billing experience
• Knowledge of ICD-10-CM and CPT coding classification systems

Physical Requirements for Essential Job Qualification

None

Occasionally

(Less than 1/3)

Frequently (1/3 to 2/3)

Majority (More than 2/3)

Remain in a stationary position

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Traverse or move around work location

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Use keyboard

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Operate or use department specific equipment

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Ascend/Descend equipment or ladder

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Position self to accomplish the Essential Functions of the role

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Receive and communicate information and ideas for understanding

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Transport, position, and/or exert force

Up to 10 pounds

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Up to 25 pounds

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Up to 50 pounds

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Up to 100 pounds

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More than 100 pounds

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The above statements are intended to describe the general nature and level of work being performed by employees in this classification. If you require a reasonable accommodation to perform the essential functions of this position, you must request accommodation in writing, within 182 days after you know or should know of the need for accommodation.

Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.