Denials & Appeals Specialist - Revenue Cycle

Shriners Children's; United States; Remote; USD 60,000 - 85,000; Full time

Job summary

Shriners Children’s in the United States seeks a Denials Management Follow Up Representative to manage payor responses after appeals. You will contact insurance carriers to ensure timely payment and apply follow up procedures across institutional and professional claims.

The role emphasizes coordination, data tracking, reporting, and collaboration with the Revenue Integrity team to improve denial management workflows and payment outcomes.

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 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 experience (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 for institutional and professional claims.
• Communicating with various individuals and monitoring day-to-day appeal follow up and denials.
• Maintaining hospital tracking tools and end-user training to support follow-up activities.
• Collecting/analyzing data, generating status reports, metrics, and trends for distribution groups.
• Organizing data and activity for timely follow up on appeals to third party payors.
• Assisting with denial and review materials for committee meetings.
• Supporting Revenue Integrity projects and coordinating payor research and documents.
• Strong communication skills and commitment to high-quality work.

Skills

Healthcare revenue cycle experience

Strong communication skills

Education

Bachelor’s Degree or equivalent

Tools

Epic EMR HB/PB

Job description

Shriners Children’s in the United States seeks a Denials Management Follow Up Representative to manage payor responses after appeals. You will contact insurance carriers to ensure timely payment and apply follow up procedures across institutional and professional claims.

The role emphasizes coordination, data tracking, reporting, and collaboration with the Revenue Integrity team to improve denial management workflows and payment outcomes.