Denials & Appeals Specialist, Revenue Cycle

Shriners Children’s Hospital; Northern (KY); On-site; USD 42,000 - 62,000; Full time

Job summary

Shriner's Children’s Hospital is seeking an Authorization Denials Representative to manage payer follow-up and appeals after SHC submissions. You will verify records, coordinate with Utilization Review, and ensure timely payment and documentation across third-party payors.

The role requires 1–3 years in healthcare revenue cycle, familiarity with 837/835 EOBs, and strong data-tracking skills. Epic EMR and SQL/Crystal Reports are a plus.

Qualifications

• 1–3 years of healthcare revenue cycle experience.
• Knowledge of Healthcare Revenue Cycle concepts and processes.
• Familiarity with 837I, 837P, 835 and EOB responses.
• Understanding of insurance contract rates and terms.
• Knowledge of registration and authorization processes.
• Experience with government and managed care billing rules.
• Epic EMR experience is preferred.
• SQL or Crystal Reports knowledge is a plus.

Responsibilities

• Coordinate payer denial and appeal follow-up to ensure timely processing.
• Maintain and update the healthcare tracking tool with follow-up activity.
• Analyze reports and trends, distributing findings as required.
• Organize data for timely follow-up on third-party payor appeals.
• Support committee materials with analyses and documents as needed.
• Assist with project work and payer research related to denials management.

Skills

Revenue cycle

Payer follow-up

Data analysis

Registration & authorization

Epic EMR

SQL/Crystal Reports

Healthcare billing rules

Education

High School Diploma/GED

Bachelor's degree (preferred)

Tools

Epic EMR

SQL

Crystal Reports

Job description

Shriner's Children’s Hospital is seeking an Authorization Denials Representative to manage payer follow-up and appeals after SHC submissions. You will verify records, coordinate with Utilization Review, and ensure timely payment and documentation across third-party payors.

The role requires 1–3 years in healthcare revenue cycle, familiarity with 837/835 EOBs, and strong data-tracking skills. Epic EMR and SQL/Crystal Reports are a plus.