Bronson Healthcare · 15 hours ago
Revenue Integrity Analyst II - Denial Management
Greater Kalamazoo Area
Full-time
Onsite
Mid, Senior Level
3+ years expBronson Healthcare is a compassionate and resilient organization seeking a Revenue Integrity Analyst II specializing in Denial Management. The role involves assessing clinical and financial information to appeal denials and ensure optimal reimbursement for the organization.
Health CareHospitalMedicalNon ProfitPrimary and Urgent Care
Responsibilities
The Denials Management Specialist assesses and utilizes clinical and financial information in relation to appealing, trending, and educating the Bronson Healthcare Group (BHG) system on retrospective denials and /or non-payment of claims
In partnership with patients, physicians and other health care providers, support the utilization of resources and obtain optimal reimbursement to assure maximum appropriate reimbursement for the organization
This includes reviewing denials of reimbursement based on medical necessity utilizing professional knowledge, expertise, application of reimbursement methodology, third-party contract language and industry accepted criteria and guideline sets (i.e., Interqual)
Responsible for creating effective appeal letters utilizing relevant and effective clinical documentation from the medical record
Qualification
Required
Bachelor's degree in Nursing or equivalent experience
3-5 years experience, preferably with managed care, denials management and/or charge capture
Licensed Registered Nurse in good standing for the State of Michigan
Minimum of 10 years nursing experience in an acute care facility
Knowledge of the operations of patient billing and payer grievance procedures
Demonstrated knowledge of insurance plans (i.e., commercial, Medicare, HMO/PPOs, etc.)
Excellent oral and written communication skills
Ability to apply medical necessity criteria based on payor requirements
Working knowledge of managed care principles and regulatory requirements and case management/discharge planning
Demonstrates excellence in the areas of leadership, teamwork, customer services, quality, and contributes to the organizations financial success
Demonstrates the ability to coordinate multiple functions
Ability to utilize word processing, spreadsheet, presentation programs, and other software relevant to the job
Regularly utilizes effective negotiation and conflict resolution skills
Formulate and submit letters of appeal
Create an effective appeal utilizing relevant and effective clinical information from the medical record, and supported by current industry clinical guidelines, community and national medical management standards and protocols
Review denials of reimbursement based on medical necessity utilizing professional knowledge, expertise, application of reimbursement methodology, and industry accepted national criteria and guideline sets (i.e., Interqual), and contract language
Preferred
Certified coding credentials preferred (CCS, CPC, etc.)
Company
Bronson Healthcare
Bronson Healthcare is a not-for-profit, group healthcare organization that provides services ranging from primary care and emergency care.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Bill Manns
President & Chief Executive Officer
Recent News
2025-10-27
2025-10-20
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