Denials Management Analyst

Shriners Children's; Tampa (FL); On-site; USD 70,000 - 90,000; Full time

Job summary

Shriner's Children’s is seeking a Denials Management Analyst to analyze denials data, track trends, and coordinate with payors and internal teams. The role supports appeals, audits, and process improvements across institutional and professional claims.

The ideal candidate has 5–7 years in healthcare revenue cycle, hands-on Epic PB Resolute experience, and strong Excel skills. CRCR/Epic certifications are preferred.

Qualifications

• Bachelor's degree or equivalent in healthcare revenue cycle.

Responsibilities

• Analyze denials data and track metrics/trends from multiple systems.
• Manage Epic work queues and resolve denials to support timely payor responses.
• Coordinate denial and audit activities for committees; prepare analyses and reports.
• Assist with mapping process improvements and rule creation in Epic.
• Maintain payer data and ensure retrievable organization of denial activities.

Skills

Denials management

Excel

Communication skills

Healthcare revenue cycle

Analytical thinking

NCCI edits/CPT-4/ICD-10 knowledge

Education

Bachelor's degree

CRCR Certification

Epic Certification

Epic PB Resolute experience

Tools

Epic PB Resolute

Job description

Company OverviewShriners 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.CURRENT EMPLOYEES: Please log into Workday Click Here to apply internally through the \"Jobs Hub\"Job DescriptionThe 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 ResponsibilitiesCollecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems Distributing reports on a routine basis to specific distribution groupManaging 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 claimsAssisting 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 reviewsMaintaining 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 trainingSupporting projects and initiatives of the Denials Management Team. This may include coordinating meetings, conducting research, performing audits or data analysis, and preparing documentsStrong communication skills and a commitment to delivering the highest level of quality workRequired Qualifications:Bachelor's degree, or equivalent combination of education and experience5-7 Years in a Healthcare Revenue Cycle Environment including 3 years in Third Party Collection/AR Receivables and Denials ManagementEpic PB Resolute experienceHealthcare Revenue Cycle management including:• Therapy (Physical/Occupational/Speech)• Radiology• Pediatrics/Pediatric Orthopedics• AnesthesiaEDI Transaction sets including 837I, 837PKnowledge of insurance contract rates and termsKnowledge and understanding of Registration and CollectionsKnowledge and understanding of Government and Managed Care billing, coverage and payment rulesAbility to comprehend payor 835 and paper EOB responsesKnowledge and understanding of NCCI edits, CPT-4, HCPCS, ICD-10 and Revenue Codes standardsIntermediate Excel skillsPreferred Qualifications:CRCR CertificationEpic CertificationCompensation is determined based on years of relevant experience and departmental equity.