Denial Prevention Analyst

Mary Free Bed Rehabilitation Hospital•Grand Rapids, MI

4d•Onsite

About The Position

The Billing & Denial Prevention Analyst plays a critical role in ensuring accurate, timely, and compliant billing for inpatient and outpatient services. This position requires deep knowledge of payer regulations and billing practices to optimize reimbursement, reduce denials, and support the financial health of the organization.

Requirements

Associate degree or equivalent experience in healthcare administration with at least 3 years of progressive experience in healthcare billing.
General experience with CPT coding and 3rd party billing requirements.
Requires analytical and communication skills necessary to explain, interpret, and present data.
Strong organizational and time management skills with the ability to manage multiple priorities and meet deadlines.
Demonstrated ability to work collaboratively across departments and with external payors.
Strong written and verbal communication skills for preparing appeals and interacting with patients and payors.
Skilled 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’ experience working with rehabilitation hospitals, inpatient/outpatient billing or specialty care is a plus.

Responsibilities

Submits accurate and timely insurance claims using billing software, ensuring compliance with payer regulations and maximizing reimbursement.
Monitors and follows up on unpaid claims, interpreting denial reasons, identifying root causes, and navigating the appeals process with appropriate documentation.
Processes insurance rejections and requests for additional information (e.g., medical records, invoices) to expedite resolution and payment.
Analyzes denial trends to identify systemic issues and recommend process improvements to leadership.
Prepares and submits written rationales for claim reconsideration requests to improve overturn rates and strengthen cash flow.
Tracks and reports denial activity in centralized systems to support data-driven decision-making.
Ensures adherence to HIPAA and all payer/governmental regulations to protect patient privacy and organizational compliance.
Reviews clinician notes and clinical documentation for completeness and accuracy to support compliant billing and minimize audit risk.
Researches and communicates changes in billing regulations to leadership, ensuring ongoing compliance and reducing denial exposure.
Supports patients by explaining balances, offering payment options, and connecting them with financial assistance programs.
Engages with patients on outstanding balances prior to collections, promoting transparency and reducing bad debt risk.
Responds to patient inquiries via phone and email with professionalism and empathy.
Partners with Access and Patient Services teams to identify training needs and improve front-end billing accuracy.
Collaborates across Revenue Cycle and clinical departments to resolve claim issues and enhance interdepartmental efficiency.
Develops and maintains strategic relationships with key payers to reduce AR days and improve revenue cycle performance.
Identifies workflow efficiencies and participate in process redesigns to support departmental financial goals.
Contributes to team success by performing other duties as assigned.
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.
Contribute by identifying problems and seeking solutions.
Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.