Easter Seals Jobs

Job Title : Medical Billing Specialist/Denial Prevention Analyst

Job Code : 2049

Department : Revenue Cycle

FLSA Class : Hourly/Non-Exempt

Reporting Relationship : Billing Manager

Mary Free Bed Summary

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.

Employment Value Proposition

At Mary Free Bed, we take pride in our values-based culture:

• Diversity, Equity, and Inclusion. Our Commitment to providing an inclusive environment for patients, families, staff, and community, through embracing Diversity, Equity, and Inclusion T.O.G.E.T.H.E.R.

• Focus on Patient Care. A selfless drive to serve and heal connects all MFB employees.

• Clinical Variety and Challenge. An inter-disciplinary approach and a top team of professionals create ever-changing opportunities and activities.

• Family Culture. We offer the stability of a large organization while nurturing the family/team atmosphere of a small organization.

• Trust in Each Other. Each employee knows that co-workers can be trusted to make the right decision for our family, patients, staff, and community.

• A Proud Tradition . Years of dedicated, quality service to our patients and community have yielded a reputation that fills our employees with pride.

  Summary

  The Medical Billing Specialist/Denial Prevention Analyst is knowledgeable of payer regulations, as it relates to area of billing responsibility to ensure compliance with billing regulations. The Medical Billing Specialist/Denial Prevention Analyst will ensure accurate and timely submission and follow up on inpatient and outpatient claims.

  Essential Job Responsibilities

• Maintain patient confidentiality as it is described in the HIPAA Privacy Act

• Submit timely, accurate and compliant insurance claims by utilizing the billing software

• Timely follow up with patients and insurance companies on all unpaid claims until resolution; this includes

• Understanding payor denial of claims reasons

• The payor appeals process and sending necessary medical records

• Resolve credit balance accounts; this includes

• Research and understanding of processed claims to determine why there’s a credit balance

• Work with insurance company to process refunds as appropriate

• 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

• Identify and report any billing system or payer issues to the Patient Financial Services System Analyst or Manager, as appropriate

• Research and identify new or updated billing regulations and notify the Revenue Cycle System Analyst and Manager

• Assist patients with payment options by explaining and offering alternative funding options

• Handle incoming patient calls/e-mails regarding patient accounts

• Assist in identifying additional educational opportunities for training of registration staff with billing regulations/requirements

• Responsible for reviewing clinician notes for appropriate documentation to ensure accurate billing

• Ensure payer and governmental agency regulatory and compliance requirements are consistently followed and applied

• Process insurance rejections, denial, or requests for additional information such as invoices and Medical Records in a timely manner

• 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

• Perform other duties as assigned by the Manager

• Embrace Diversity, Equity and Inclusion, by:

  T reating everyone with dignity and respect

  O pening more doors to opportunities for underrepresented cultures

  G rowing talent and people

  E valuating and eliminating disparities

  T aking action against injustices, bias and racism

  H onoring our differences and how to collaborate

  E ducating staff, patients and the communities we care for

  R estoring 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

• High school education or equivalent; associates degree preferred.

• Three to five years experience rehabilitation hospital medical billing.

• Knowledge of third party billing regulations.

• Proficient time management and organizational skills.

• Ability to problem-solve and work effectively as a team member.

• Effective written and verbal communication skills.

  Preferred Job Qualifications

• Certification as Certified Professional Coder (CSC), Certified Coding Specialist-Professional (CCS-P), or Certified Medical Reimbursement Specialist (CMRS)

  Physical Requirements for Essential Job Qualification

  Levels :

• None (No specific requirements)

• Occasionally (Less than 1/3)

• Frequently (1/3 to 2/3)

• Majority (More than 2/3)

  Remain in a stationary position: Majority

  Traverse or move around work location: None

  Use keyboard: Frequently

  Operate or use department specific equipment: None

  Ascend/Descend equipment or ladder: None

  Position self to accomplish the Essential Functions of the role: None

  Receive and communicate information and ideas for understanding: None

  Transport, position, and/or exert force:

  Up to 10 pounds: Occasionally

  Up to 25 pounds: None

  Up to 50 pounds: None

  Up to 75 pounds: None

  More than 100 pounds: None

  Other weight: Up to_ pounds None

  Other: None

  Compensation based on experience, starting from $19.50.

  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.