Denials & Revenue Optimization Analyst

OpenTalent; United States; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

403(b) and Roth 403(b) with company-ḿ

tuition reimbursement

life insurance

short-term and long-term disability

Health Savings Account (HSA)

Flexible Spending Account (FSA)

paid time off

Job summary

Shriners Children’s is seeking a Denials Management Analyst to analyze denials data, create payor metrics, and track trends across multiple systems. You will identify root causes, report findings, and help map process improvements while coordinating denial and audit activities for timely responses on both institutional and professional claims.

The role involves managing Epic work queues, gathering data for rule creation, and researching payer manuals to address non-covered denials.

Qualifications

• Gather data to substantiate requests for rule creations in Epic.
• Research payer fee schedules and provider manuals to ensure appropriate non-covered denials.
• Organize data and activity for retrievable records; coordinate denial and audit activities for timely responses.
• Assist with committee meeting materials, analyses, and reports related to denials.

Responsibilities

• 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/ap

Skills

Data analysis

Epic experience

Denials management

Process improvement

Communication

Tools

Epic

Job description

Shriners Children’s is seeking a Denials Management Analyst to analyze denials data, create payor metrics, and track trends across multiple systems. You will identify root causes, report findings, and help map process improvements while coordinating denial and audit activities for timely responses on both institutional and professional claims.

The role involves managing Epic work queues, gathering data for rule creation, and researching payer manuals to address non-covered denials.