Anesthesia Billing Specialist — Denials & AR Expert

Embedded Shishya; United States; Remote; USD 33,000 - 50,000; Full time

Job summary

Shriners Children’s in the United States seeks a Professional Billing Specialist (Anesthesia) to manage all professional billing requirements and AR tasks, ensuring compliance with regulatory and payer guidelines.

You will coordinate payor denial and appeal follow-up, maintain tracking tools, and collaborate with payer relations and billing teams to reduce denials and accelerate reimbursements.

Qualifications

• Epic PB Resolute experience required.
• 3 years of anesthesia experience.
• 5 years in Healthcare/Hospital Revenue Cycle including Third Party AR.
• Knowledge of 837P EDI transactions.
• Understanding of CPT/HCPCS/ICD-10 and Revenue Codes.
• Bachelor’s Degree or equivalent.
• Certification in Epic PB Resolute or plan to obtain within 12 months.

Responsibilities

• Coordinating payor denial and appeal follow up activities to ensure timely response from third party payors and the processing of all payor denials, documentation requests and appeals
• Review all denial accounts for categorization, level of appeal, special requirements for initiating appeals
• Communicate global payer issues with the payer relations team
• Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities related to appeal follow up and denials
• Maintaining the healthcare tracking tool/application that stores/communicates all claim edits, review and denial activity.
• Monitor all Claim Edit and Denial Management work queues and lists to ensure they are fully resolved.
• Ensure medical records requests are completed and submitted within 48 hours.
• Track all denials on a database to determine outcome. Collecting/analyzing, report status, metrics and trends of activity by different reviews from the tool.
• Distributing reports on a routine basis to specific distribution group.
• Organizing all data and activity in a retrievable way to ensure timely follow up on appeals to third party payors.
• Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc.
• Knowledgeable about federal, state and third-party claims processing.
• Supporting projects and initiatives of the Billing and Denials Management teams.
• This may include coordinating meetings, conducting research for payor criteria, and preparing documents
• Able to build and maintain relationships with payer representatives

Skills

Epic PB Resolute

Anesthesia experience

Revenue cycle

EDI 837P

Insurance contracts

Registration & collections

Government & managed care

Payor 835 / EOB

CPT / HCPCS / ICD-10

Excel

Certification in Epic PB Resolute

Bachelor's degree

Education

Bachelor’s Degree or equivalent

Tools

SQL

Crystal Reports

Job description

Shriners Children’s in the United States seeks a Professional Billing Specialist (Anesthesia) to manage all professional billing requirements and AR tasks, ensuring compliance with regulatory and payer guidelines.

You will coordinate payor denial and appeal follow-up, maintain tracking tools, and collaborate with payer relations and billing teams to reduce denials and accelerate reimbursements.