Denials & Appeals Revenue Cycle Specialist

150 Shriners Hospitals for Children; United States; On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Tuition assistance

Retirement matching

Job summary

Shriners Children's in the United States is seeking a Denials Management Follow Up Representative to coordinate payor denial and appeal follow up, ensuring timely payment after appeals. You will maintain tracking tools, analyze metrics, develop routine reports, and support Revenue Integrity projects.

Strong communication and understanding of hospital revenue cycle are essential. Join a mission-driven team across U.S.

Qualifications

• 5-7 years in a healthcare patient accounting revenue cycle environment.
• Knowledge of Hospital Revenue Cycle revenue management.
• EDI Transaction sets including 837I, 837P.
• Understanding of Registration and Collections.
• Understanding of Government and Managed Care billing, coverage and payment rules.
• Ability to comprehend payor 835 and paper EOB responses.
• Understanding of CCI edits, CPT, HCPCS, ICD-10 and Revenue Codes.
• Epic EMR (HB and/or PB).
• Bachelor's Degree or equivalent combination of education and experience in lieu of degree.

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 for both institutional and professional claims.
• 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 hospital tracking tool/application that stores/communicates all denial and review activity.
• Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems.
• Developing 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.
• Supporting projects and initiatives of the Revenue Integrity team.
• Strong communication skills and a commitment to delivering the highest level of quality work.

Skills

Healthcare revenue cycle

EDI 837I/837P

Registration & Collections

Government & Managed Care billing

Payor 835 & EOB understanding

CCI edits CPT HCPCS ICD-10

Education

Bachelor's degree or equivalent

Tools

Epic EMR (HB/PB)

Job description

Shriners Children's in the United States is seeking a Denials Management Follow Up Representative to coordinate payor denial and appeal follow up, ensuring timely payment after appeals. You will maintain tracking tools, analyze metrics, develop routine reports, and support Revenue Integrity projects.

Strong communication and understanding of hospital revenue cycle are essential. Join a mission-driven team across U.S.