Billing & Denial Prevention Analyst

Mary Free Bed Rehabilitation Hospital•Grand Rapids, MI

About The Position

The Billing & Denial Prevention Analyst supports accurate, timely, and compliant billing for inpatient and outpatient services. The role applies knowledge of payer regulations and billing practices to optimize reimbursement, reduce claim denials, and support the organization’s financial health. Responsibilities also include patient financial engagement, collaboration across revenue cycle and clinical teams, and ongoing process improvement. Mary Free Bed is a not-for-profit, nationally accredited rehabilitation hospital serving children and adults through inpatient, outpatient, sub-acute rehabilitation, orthotics and prosthetics, and home and community programs. Its mission is restoring hope and freedom through rehabilitation.

Requirements

Associate degree or equivalent experience in healthcare administration.
At least 3 years of progressive experience in healthcare billing.
General experience with CPT coding and third-party billing requirements.
Analytical and communication skills to explain, interpret, and present data.
Strong organizational and time management skills, including the ability to manage multiple priorities and meet deadlines.
Ability to work collaboratively across departments and with external payers.
Strong written and verbal communication skills for preparing appeals and interacting with patients and payers.
Proficiency in Microsoft Office Suite, especially Excel for data tracking and reporting.
Empathetic and professional approach to patient financial counseling and inquiries.

Nice To Haves

Certification as Certified Professional Coder (CSC), Certified Coding Specialist-Professional (CCS-P), or Certified Medical Reimbursement Specialist (CMRS).
Three to five years of experience with rehabilitation hospitals, inpatient/outpatient billing, or specialty care.

Responsibilities

Submit accurate and timely insurance claims using billing software in compliance with payer regulations.
Monitor unpaid claims, interpret denial reasons, identify root causes, and pursue appeals with appropriate documentation.
Process insurance rejections and requests for additional information, such as medical records and invoices.
Analyze denial trends, identify systemic issues, and recommend process improvements to leadership.
Prepare and submit written rationales for claim reconsideration requests.
Track and report denial activity in centralized systems.
Ensure compliance with HIPAA and payer and governmental regulations.
Review clinician notes and clinical documentation for completeness and accuracy to support compliant billing and minimize audit risk.
Research and communicate billing regulation changes to leadership.
Explain patient balances, offer payment options, and connect patients with financial assistance programs.
Engage with patients regarding outstanding balances before collections and respond to inquiries by phone and email.
Partner with Access and Patient Services teams to identify training needs and improve front-end billing accuracy.
Collaborate with Revenue Cycle and clinical departments to resolve claim issues and improve interdepartmental efficiency.
Develop and maintain relationships with key payers to reduce accounts receivable days and improve revenue cycle performance.
Identify workflow efficiencies and participate in process redesigns.
Perform other duties as assigned.
Demonstrate excellent customer service and behavioral standards; encourage, coach, and monitor the same in team members.
Promote teamwork and direct communication, and handle confidential information discreetly and sensitively.
Identify problems and seek solutions; promote patient and family satisfaction and participate in departmental customer service monitoring and reporting.