Payor Reimbursement & Denials Specialist

Children's National Hospital; Silver Spring (MD); On-site; USD 87,000 - 145,000; Full time

Job summary

Children's National Hospital in Silver Spring, MD, seeks a Payor Reimbursement Analyst to support financial sustainability through reconciliation of Medicaid and commercial payors. A BSN is required with 5 years of experience, including 3 years in Utilization Review.

Responsibilities include reviewing authorizations/denials, filing timely appeals per InterQual/MCG, and analyzing payor data for process improvements. Strong Excel/Access skills and professional communication are essential.

Qualifications

• BSN is required.
• 5 years of experience with 3 years in Utilization Review.
• Strong written business communication is essential.
• Proficiency with MS Office (Excel, Access, PowerPoint) required.
• Ability to critically think and apply logic in dynamic healthcare environment.

Responsibilities

• Review authorizations/denials promptly to determine actions.
• Provide clear guidance to resolve authorization/denial issues.
• File timely appeals using InterQual and MCG criteria with escalation when needed.
• Track payor responses to appeals to ensure timely payments or write-offs.
• Analyze denial data by payor and report trends to Revenue Cycle.
• Educate CRM, staff and hospital teams about authorization and denial patterns.

Skills

Analytical thinking

Verbal communication

Service orientation

Education

BSN (Required)

Master's Degree (Preferred)

Tools

Microsoft Excel

Microsoft Access

PowerPoint

Job description

Children's National Hospital in Silver Spring, MD, seeks a Payor Reimbursement Analyst to support financial sustainability through reconciliation of Medicaid and commercial payors. A BSN is required with 5 years of experience, including 3 years in Utilization Review.

Responsibilities include reviewing authorizations/denials, filing timely appeals per InterQual/MCG, and analyzing payor data for process improvements. Strong Excel/Access skills and professional communication are essential.