This job listing has expired and the position may no longer be open for hire.

Denial Prevention Analyst at Mary Free Bed Rehabilitation

Posted in Other 30+ days ago.

Type: Full Time
Location: Grand Rapids, Michigan





Job Description:

We have the great privilege of helping patients and families re-build their lives. It's extraordinarily meaningful work and the reason we greet the day with optimism and anticipation. When patients \\"Ask for Mary,\\" they experience a culture that has been sculpted for more than a century. Our hallmark is to carefully listen to patients and innovatively serve them. This is true of every employee, from support staff and leadership, to clinicians and care providers.

Mary Free Bed is a not-for-profit, nationally accredited rehabilitation hospital serving thousands of children and adults each year through inpatient, outpatient, sub-acute rehabilitation, orthotics and prosthetics and home and community programs. With the most comprehensive rehabilitation services in Michigan and an exclusive focus on rehabilitation, Mary Free Bed physicians, nurses and therapists help our patients achieve outstanding clinical outcomes. The growing Mary Free Bed Network provides patients throughout the state with access to our unique standard of care.

Mission Statement

Restoring hope and freedom through rehabilitation.

Diversity and Inclusion:

Mary Free Bed values diversity and inclusion among patients, families and staff. We strive to hire people who reflect the communities we serve. Our employees will serve all patients, families and each other with dignity and respect.

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

Essential Job Qualifications (Knowledge, Education, and Training Requirements)

- 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

- Physical Demands: Able to exert up to 10 pounds of force occasionally (up to 1/3 of the time); able to lift, carry, push, pull, up to 10 pounds occasionally; able to sit for the majority of the time, but may involve brief periods of time walking or standing; able to use keyboard frequently (1/3 to 2/3 of the time)

Other Preferred Job Qualifications

- IRF medical billing experience

- Knowledge of ICD-9-CM and CPT coding classification systems

.

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.


More jobs in Grand Rapids, Michigan


Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan
More jobs in Other


Tyson Foods, Inc.

Tyson Foods, Inc.

Tyson Foods, Inc.