Denials & Appeals Follow-Up Specialist

Shriners Children's; Tampa (FL); Presencial; USD 55.000 - 75.000; Jornada completa

Descripción de la vacante

Shriners Children’s is seeking a Denials Management Follow Up Representative to coordinate payor denial and appeal activities and drive timely payment after appeals have been filed. You’ll work with third-party payors, maintain denial tracking, and generate reports to support Revenue Integrity initiatives.

You’ll leverage 5–7 years in healthcare revenue cycle, EDI/837 experience, and Epic EMR knowledge to improve claims processing and outcome tracking in a dynamic pediatric care setting.

Formación

• 5-7 years in healthcare patient accounting revenue cycle.
• Knowledge of Hospital Revenue Cycle revenue management and EDI transaction sets (837I, 837P).
• Understanding of Registration and Collections.
• Understanding of Government and Managed Care billing, coverage and payment rules.
• Experience with payor denials and appeals processes.

Responsabilidades

• Coordinate 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.
• Communicate and coordinate with various individuals and distributions and assist with monitoring day-to-day activities related to appeal follow up and denials.
• Maintain the hospital tracking tool/application that stores/communicates all denial and review activity, including access management and end-user training.
• Collect/analyze status, metrics and trends of activity from multiple systems and develop routine reports for distribution groups.
• Organize data and activity for retrievable follow-up on appeals to third party payors.
• Assist with coordination of denial and review materials for committee meetings and prepare analyses and reports.
• Support Revenue Integrity projects including coordinating meetings and researching payor criteria.

Conocimientos

Communication skills

Revenue cycle knowledge

EDI knowledge

Hospital billing

Analytical reporting

Educación

Bachelor's Degree

Herramientas

Epic EMR

Descripción del empleo

Shriners Children’s is seeking a Denials Management Follow Up Representative to coordinate payor denial and appeal activities and drive timely payment after appeals have been filed. You’ll work with third-party payors, maintain denial tracking, and generate reports to support Revenue Integrity initiatives.

You’ll leverage 5–7 years in healthcare revenue cycle, EDI/837 experience, and Epic EMR knowledge to improve claims processing and outcome tracking in a dynamic pediatric care setting.