Job Information
Bronson Healthcare Group Revenue Integrity Analyst I- Denial Management in Kalamazoo, Michigan
Love Where You Work!
Team Bronson is compassionate, resilient and strong. We are driven by Positivity which inspires us to be our best and to go above and beyond for our patients, for one another, and for our community. If you're ready for a rewarding new career, join Team Bronson and be part of the experience.
About the Role
As a Revenue Integrity Analyst I at Bronson Healthcare Group, the role involves analyzing and leveraging clinical and financial data to address retrospective denials or non-payment of claims. Collaborating with patients, physicians, and other healthcare providers, the aim is to optimize resource utilization and secure maximum appropriate reimbursement for the organization. This includes reviewing reimbursement denials based on medical necessity, utilizing professional expertise, reimbursement methodologies, third-party contract terms, and industry-accepted criteria such as Interqual. Crafting effective appeal letters using pertinent clinical documentation from medical records is a key responsibility. Employees involved in direct patient care are expected to demonstrate competencies tailored to the served population.
Qualifications:
- Bachelor's Degree in Health Information Technology, Business Administration, or related field, with 2-3 years of experience in coding/patient accounting, or equivalent education/experience.
- Preferred experience in insurance, managed care, and denials management.
- AHIMA or AAPC coding credentials (CCA, CCS, CCS-P, CPC, CPC-H, RHIT, or RHIA) required, or obtainable within 6 months of hire.
Proficiency in coding (CPT, ICD9, and preferably ICD10).
Responsibilities:
- Utilizing Epic software effectively, managing multiple work queues, and understanding workflow and processes.
- Applying knowledge of managed care principles and regulatory requirements.
- Excelling in leadership, teamwork, customer service, and contributing to financial success.
- Coordinating multiple functions efficiently.
- Utilizing word processing, Excel spreadsheets, presentation programs, and relevant software.
- Effective communication with internal (physician offices, multi-disciplinary team, finance, management) and external (patients, third-party payers, insurance representatives, community agencies) stakeholders.
- Utilizing negotiation and conflict resolution skills as required.
- Maintaining regular communication with all members of the revenue cycle.
- Identifying and resolving charging issues and commercial payer denials.
- Performing charge entry and invoice reconciliation for Fresenius and Davita.
- Conducting bedside procedure pricing for HIM.
- Identifying and reporting errors/problems with Event Management (registration) and accommodation codes.
- Participating in audits, reviews, and appeal activities.
- Identifying denial trends, operational issues, and payer changes.
- Maintaining awareness of healthcare trends, reimbursement methodologies, and utilization management through professional development activities.
- Managing audit dashboard reporting and maintenance.
- Serving as a resource for verification and physician offices on denials due to coverage changes, collaborating to resolve issues.