Anesthesia Denials Analytics Specialist

Embedded Shishya; United States; Remote; USD 85,000 - 110,000; Full time

Job summary

Shriners Children’s is seeking a Denials Management Analyst (Anesthesia) to analyze denials data, track payor metrics, and coordinate denials and audits across multiple systems. The role involves identifying root causes, supporting process improvements, and ensuring timely responses for payor denials and appeals.

Qualifications include a bachelor’s degree or equivalent, 3 years anesthesia experience, and 5-7 years in Healthcare Revenue Cycle with denials management; Epic PB Resolute experience

Qualifications

• Bachelor's degree or equivalent combination of education and experience.
• 3 years of anesthesia experience.
• 5-7 years in Healthcare Revenue Cycle including 3 years in Third Party Collection/AR Receivables and Denials Management.
• Epic PB Resolute experience.
• EDI Transaction sets including 837I, 837P.
• Knowledge of insurance contract rates and terms.
• Knowledge of Government and Managed Care billing, coverage and payment rules.
• Knowledge of payor 835 and paper EOB responses.
• Knowledge of NCCI edits, CPT-4, HCPCS, ICD-10 and Revenue Codes standards.
• Intermediate Excel skills.

Responsibilities

• Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems.
• Distributing reports on a routine basis to specific distribution group.
• Managing Epic work queues and resolving denials.
• Gathering data to substantiate the request for rule creations in Epic.
• Research payer fee schedules and provider manuals to ensure appropriate non-covered denials.
• Organizing data and activity in a retrievable way; coordinating payor denial and audit activities.
• Assisting with coordination of denial and review activities for committee meetings.
• Communicating with various individuals and monitoring day-to-day denial/audit activities.
• Maintaining the healthcare tracking tool and user access management.

Skills

Communication

Excel

Education

Bachelor's degree

Equivalent education/experience

Tools

Epic PB Resolute

Job description

Shriners Children’s is seeking a Denials Management Analyst (Anesthesia) to analyze denials data, track payor metrics, and coordinate denials and audits across multiple systems. The role involves identifying root causes, supporting process improvements, and ensuring timely responses for payor denials and appeals.

Qualifications include a bachelor’s degree or equivalent, 3 years anesthesia experience, and 5-7 years in Healthcare Revenue Cycle with denials management; Epic PB Resolute experience