Denials Management Analyst

Shriners Children’s Hospital; Northern (KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Shriners Children's is seeking a Denials Management Analyst to analyze denials data, track payor metrics, and coordinate denial and audit activities across multiple systems, including Epic PB Resolute. The role supports root-cause analysis and process improvement to ensure timely responses for all payor denials and appeals.

The position requires 5–7 years in healthcare revenue cycle with Epic PB Resolute experience, strong communication, and intermediate Excel skills.

Qualifications

• Bachelor's degree, or equivalent combination of education and experience.
• 5-7 years in a Healthcare Revenue Cycle Environment including 3 years in Third Party Collection/AR Receivables and Denials Management with Epic PB Resolute experience.
• Knowledge of insurance contract rates and terms; Government and Managed Care billing rules.
• Intermediate Excel skills.
• Experience with denials management and payor auditing processes.

Responsibilities

• Collecting and analyzing metrics and trends from multiple systems.
• Distributing routine reports to designated groups.
• Managing Epic work queues and resolving denials.
• Gathering data to support rule creation in Epic.
• Researching payer fee schedules and provider manuals to identify non-covered denials.
• Organizing data and activity in a retrievable format.
• Coordinating payor denial and audit activities for timely responses to denials and audit requests for institutional and professional claims.
• Assisting with coordination of denial and review materials for committee meetings.
• Communicating with stakeholders and monitoring day-to-day denials and audit reviews.
• Maintaining the healthcare tracking tool that stores denial and review activity, including access management and training.
• Supporting Denials Management projects, including meetings, research, audits, data analysis, and documentation.
• Strong communication and commitment to high-quality work.

Skills

Analytical skills

Communication skills

Excel

Attention to detail

Revenue Cycle knowledge

Education

Bachelor's degree or equivalent

Tools

Epic PB Resolute

Epic Certification

CRCR Certification

Job description

Company Overview Shriners Children's is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families. With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family’s ability to pay or insurance status. Please click here to learn more about our locations.

Job Description

The Denials Management Analyst is responsible for analyzing denials data, creating payor metrics, as well as tracking and trending denials and result out of multiple systems. The analyst will identify and trend root causes and report out findings as well as assist in mapping out process improvement opportunities. The Analyst will coordinate payor denials and audit activities to ensure timely response for the processing of all payor denials, audit requests and appeals. The Analyst will communicate and coordinate with various individuals/distributions and assist with monitoring of the day-to-day activities related to claims denials and audit reviews.

Key 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 all data and activity in a retrievable way
• Coordinating payor denial and audit activities to ensure timely response for the processing of all payor denials, audit request and appeals for both institutional and professional claims
• Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc.
• Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities related to claim denials and audit reviews
• Maintaining the healthcare tracking tool/application that stores/communicates all denial and review activity. This will include user access management, updates to software, and end-user training
• Supporting projects and initiatives of the Denials Management Team. This may include coordinating meetings, conducting research, performing audits or data analysis, and preparing documents
• Strong communication skills and a commitment to delivering the highest level of quality work

Required Qualifications

• Bachelor's degree, or equivalent combination of education and experience
• 5-7 Years in a Healthcare Revenue Cycle Environment including 3 years in Third Party Collection/AR Receivables and Denials Management Epic PB Resolute experience
• Healthcare Revenue Cycle management including:
• Therapy (Physical/Occupational/Speech)
• Radiology
• Pediatrics/Pediatric Orthopedics
• Anesthesia
• EDI Transaction sets including 837I, 837P
• Knowledge of insurance contract rates and terms
• Knowledge and understanding of Registration and Collections
• Knowledge and understanding of Government and Managed Care billing, coverage and payment rules
• Ability to comprehend payor 835 and paper EOB responses
• Knowledge and understanding of NCCI edits, CPT-4, HCPCS, ICD-10 and Revenue Codes standards
• Intermediate Excel skills

Preferred Qualifications

• CRCR Certification
• Epic Certification

Compensation is determined based on years of relevant experience and departmental equity.

Every day, we provide innovative, compassionate care and conduct leading research that enhances the quality of life for children and their families. We invite you to explore the many rewarding career paths at Shriners Children's, from clinical and non-clinical positions to education and research opportunities. We’re always looking for driven, compassionate professionals to join our team as nurses, physical therapists, medical assistants, administrative staff and so much more. No matter where you're located, you'll find openings at our Shriners Children’s facilities across the U.S., in Canada and Mexico and at our corporate headquarters in Tampa, Florida.

Eligible Shriners Children's employees receive comprehensive benefits packages, including medical, dental and vision insurance, tuition assistance, retirement matching and so much more!