Denials Management Follow Up Representative

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

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 Follow Up Representative is responsible for following up on payor responses to Shriners Children’s submitted appeals. The Representative will contact insurance carriers to ensure timely payment and collection of money due to the Shriners Children’s organization after the appeals process has successfully taken place.

Key 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. This will include user access management, updates to software, and end-user training to support all follow-up activities.

• 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. This may include coordinating meetings, conducting research for payor criteria, and preparing documents.

• Strong communication skills and a commitment to delivering the highest level of quality work.

Required 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 Insurance contract rates and terms

• 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

Preferred Qualifications

• 3 years in Hospital Third Party Collection/AR Receivables

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