Healthcare Denials Management Analyst

Socket.dev; St. Louis (MO); On-site; USD 70,000 - 100,000; Full time

Job summary

Shriners Children’s in St. Louis, MO is seeking a Denials Management Analyst to analyze denials data, track metrics, and coordinate payor denial activities across multiple systems.

You will identify root causes and support process improvements, audits, and appeals for both institutional and professional claims. The role requires a Bachelor's degree, 5–7 years in Healthcare Revenue Cycle with denials management, and knowledge of Epic PB Resolute, EDI 837I/837P, and payer contract rules; strong

Qualifications

• Bachelor's degree or equivalent experience in a related field.
• 5-7 years in a Healthcare Revenue Cycle environment with 3 years in third party collections/AR denials.
• Experience with Epic PB Resolute and payer denials workflows.
• Knowledge of insurance contract rates, Government and Managed Care rules, and payor 835/EOB.
• Familiarity with CPT-4, HCPCS, ICD-10 and revenue codes; strong Excel skills.

Responsibilities

• Collect, analyze, and report denials data and trends across multiple systems.
• Manage Epic work queues and resolve denials; support rule creation in Epic.
• Research payer fee schedules and provider manuals for non-covered denials.
• Coordinate payor denial and audit activities for timely responses and appeals.
• Prepare materials for committee reviews and ensure data retrievability.

Skills

Communication

Attention to detail

Education

Bachelor's degree

CRCR Certification

Epic Certification

Tools

Epic PB Resolute

Microsoft Excel

EDI 837I/837P

Job description

Shriners Children’s in St. Louis, MO is seeking a Denials Management Analyst to analyze denials data, track metrics, and coordinate payor denial activities across multiple systems.

You will identify root causes and support process improvements, audits, and appeals for both institutional and professional claims. The role requires a Bachelor's degree, 5–7 years in Healthcare Revenue Cycle with denials management, and knowledge of Epic PB Resolute, EDI 837I/837P, and payer contract rules; strong