Professional Billing Specialist (Anesthesia)

150 Shriners Hospitals for Children; United States; On-site; USD 33,000 - 50,000; Full time

Benefits offered by this job

Medical insurance

Tuition assistance

Retirement matching

Job summary

Shriners Children’s is seeking a Professional Billing Specialist (Anesthesia) to manage all professional billing requirements and AR tasks per regulatory and payor guidelines. This role involves coordinating denials, appeals, and reporting using Epic PB Resolute within a hospital revenue cycle context.

The ideal candidate has anesthesia billing experience (5+ years), Epic PB Resolute proficiency, and strong knowledge of CPT/HCPCS, ICD-10, and 837P, with solid Excel skills and a commitment to

Qualifications

• Epic PB Resolute certification (or willingness to obtain within 12 months)
• Anesthesia revenue cycle experience (5+ years) in a healthcare/hospital setting
• Strong knowledge of 837P, CPT/HCPCS, ICD-10, and revenue codes
• Experience with payor denials, AR, and denial management
• Intermediate Excel skills and data reporting capabilities
• Experience with government and managed care billing rules and adjustments
• Understanding of insurance contracts and payment terms

Responsibilities

• Coordinate payor denial and appeal follow-up activities and ensure timely responses
• Communicate with payer relations and internal teams to address denials
• Maintain healthcare tracking tools for edits, reviews, and denial activity
• Monitor claim edits and denial work queues to ensure resolution
• Ensure timely medical records requests and submission (within 48 hours)
• Track and report denials, outcomes, and trends via databases and reports
• Prepare materials for committee meetings and coordinate related data/reports
• Support Billing and Denials Management projects and payer criteria research

Skills

Epic PB Resolute

Anesthesia experience

Healthcare Revenue Cycle

EDI 837P

Insurance contract rates

Registration & Collections

Government & Managed Care billing

Payor 835 & EOB

CPT/HCPCS/ ICD-10 codes

Excel skills

Managed care systems

Certification in Epic PB Resolute

Education

Bachelor’s Degree or equivalent

Job description

Company Overview

Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families. With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family’s ability to pay or insurance status. Please click here to learn more about our locations.

Job Description

The Professional Billing Specialist (Anesthesia) is responsible for managing all professional billing requirements and managing accounts receivable tasks according to standard and productivity measurements. Responsible to ensure all regulatory and payor guidelines are followed.

Key Responsibilities

• Coordinating payor denial and appeal follow up activities to ensure timely response from third party payors and the processing of all payor denials, documentation requests and appeals Review all denial accounts for categorization, level of appeal, special requirements for initiating appeals Communicate global payer issues with the payer relations team.
• Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities related to appeal follow up and denials.
• Maintaining the healthcare tracking tool/application that stores/communicates all claim edits, review and denial activity. This will include user access management, updates to software, and end-user training to support all follow up activities.
• Monitor all Claim Edit and Denial Management work queues and lists to ensure they are fully resolved.
• Ensure medical records requests are completed and submitted within 48 hours.
• Track all denials on a database to determine outcome.
• Collecting/analyzing, report status, metrics and trends of activity by different reviews from the tool.
• Distributing reports on a routine basis to specific distribution group.
• Organizing all data and activity in a retrievable way to ensure timely follow up on appeals to third party payors.
• Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc.
• Knowledgeable about federal, state and third-party claims processing.
• Supporting projects and initiatives of the Billing and Denials Management teams. This may include coordinating meetings, conducting research for payor criteria, and preparing documents Able to build and maintain relationships with payer representatives.

Required Qualifications

• Epic PB Resolute experience 3 years of related
• Anesthesia experience 5 years' experience in a Healthcare/Hospital Revenue Cycle Environment including Third Party Collection/AR Receivables
• Healthcare Revenue Cycle revenue management
• EDI Transaction sets including 837P
• Knowledge of insurance contract rates and terms
• Understanding of Registration and Collections
• Understanding of Government and Managed Care billing, coverage and payment rules
• Ability to comprehend payor 835 and paper EOB responses
• Understanding of CCI edits, CPT, HCPCS, ICD-10 and Revenue Codes
• Intermediate Excel skills
• Excellent computer skills, especially spreadsheet and database applications.
• Knowledge of managed care patient financial systems and of the specific billing and payment standards utilized for services provided within a hospital setting.
• Thorough understanding of managed care payment methodologies and the principles of managed care.
• Certification in Epic PB Resolute - or agree to obtain certification within 12 months after hire
• Bachelor’s Degree or equivalent combination of education and experience

Preferred Qualifications

• Knowledge of SQL or Crystal Reports.
• HFMA’s CRCR credential

Salary / Compensation

The pay range for this position is $24.16 - $36.24. Compensation is determined based on years of relevant experience and departmental equity.

Benefits

Eligible Shriners Children’s employees receive comprehensive benefits packages, including medical, dental and vision insurance, tuition assistance, retirement matching and so much more!

Every day, we provide innovative, compassionate care and conduct leading research that enhances the quality of life for children and their families. We invite you to explore the many rewarding career paths at Shriners Children's, from clinical and non-clinical positions to education and research opportunities. We’re always looking for driven, compassionate professionals to join our team as nurses, physical therapists, medical assistants, administrative staff and much more. No matter where you're located, you'll find openings at our Shriners Children’s facilities across the U.S., in Canada and Mexico and at our corporate headquarters in Tampa, Florida.