Payer Denials & Appeals Coordinator

150 Shriners Hospitals for Children; United States; On-site; USD 42,000 - 66,000; Full time

Job summary

Shriners Children’s is seeking an Authorization Denials Representative to follow up with payers after appeals. You will verify records, coordinate with Utilization Review, and ensure timely payment for SHC.

The role requires attention to detail and collaboration with team members. You will maintain tracking tools, prepare reports, support committee materials, and participate in initiatives of the Authorization Denials Management team.

Qualifications

• 1-3 years of healthcare revenue cycle experience.
• Knowledge of Healthcare Revenue Cycle revenue management.
• Knowledge of 837I, 837P, 835 and EOB responses.
• Knowledge of insurance contract rates and terms.
• Knowledge of registration and authorization processes.
• Knowledge of government and managed care billing, coverage, authorization and payment rules.
• High School Diploma/GED.

Responsibilities

• Coordinate payer denial and appeal follow up with third-party payers.
• Maintain healthcare tracking tool to store denial and review activity.
• Collect and analyze reports on status, metrics, and trends.
• Distribute reports to distribution groups.
• Organize data for timely follow up on appeals.
• Coordinate materials for committee meetings and prepare analyses.
• Support Authorization Denials Management projects.
• Verify concurrent review records with payers and UR.

Skills

Healthcare revenue cycle experience

Insurance billing knowledge

Government and managed care billing

Education

High School Diploma/GED

Bachelor's degree

Tools

Epic EMR

SQL

Crystal Reports

Job description

Shriners Children’s is seeking an Authorization Denials Representative to follow up with payers after appeals. You will verify records, coordinate with Utilization Review, and ensure timely payment for SHC.

The role requires attention to detail and collaboration with team members. You will maintain tracking tools, prepare reports, support committee materials, and participate in initiatives of the Authorization Denials Management team.