Payor Reimbursement Analyst — Denials & Revenue Insight

10100 Children's Hospital; United States; On-site; USD 87,000 - 145,000; Full time

Job summary

Children’s National Hospital in Silver Spring, MD is seeking a Payor Reimbursement Analyst to support financial sustainability through Medicaid and Commercial payor research. You will track denials, assist with appeals, and collaborate with Revenue Cycle, Access, Clinics, Managed Care and Legal.

Required BSN; 5+ years of experience with 3 years in Utilization Review. Strong communication, business writing and MS Office skills are essential for success in this role.

Qualifications

• BSN required; Master’s degree preferred for progression.
• At least 5 years of work experience with 3 years in Utilization Review.
• Strong verbal and written communication skills; proficient in MS Office.

Responsibilities

• Authorize and deny decisions with timely, accurate review and clear direction.
• Track, trend and analyze authorization issues and denials by payor.
• Collaborate with CRM, Revenue Cycle, and hospital staff to optimize reimbursement.
• Educate staff on authorization processes and denial patterns.

Skills

Utilization Review

Verbal communication

Business writing

Education

BSN

Master's degree (preferred)

Tools

Microsoft Excel

Microsoft Access

Microsoft PowerPoint

Job description

Children’s National Hospital in Silver Spring, MD is seeking a Payor Reimbursement Analyst to support financial sustainability through Medicaid and Commercial payor research. You will track denials, assist with appeals, and collaborate with Revenue Cycle, Access, Clinics, Managed Care and Legal.

Required BSN; 5+ years of experience with 3 years in Utilization Review. Strong communication, business writing and MS Office skills are essential for success in this role.