Strategic Denials Management Analyst

Shriners Children’s Hospital; Northern (KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Shriners Children's is seeking a Denials Management Analyst to analyze denials data, track payor metrics, and coordinate denial and audit activities across multiple systems, including Epic PB Resolute. The role supports root-cause analysis and process improvement to ensure timely responses for all payor denials and appeals.

The position requires 5–7 years in healthcare revenue cycle with Epic PB Resolute experience, strong communication, and intermediate Excel skills.

Qualifications

• Bachelor's degree, or equivalent combination of education and experience.
• 5-7 years in a Healthcare Revenue Cycle Environment including 3 years in Third Party Collection/AR Receivables and Denials Management with Epic PB Resolute experience.
• Knowledge of insurance contract rates and terms; Government and Managed Care billing rules.
• Intermediate Excel skills.
• Experience with denials management and payor auditing processes.

Responsibilities

• Collecting and analyzing metrics and trends from multiple systems.
• Distributing routine reports to designated groups.
• Managing Epic work queues and resolving denials.
• Gathering data to support rule creation in Epic.
• Researching payer fee schedules and provider manuals to identify non-covered denials.
• Organizing data and activity in a retrievable format.
• Coordinating payor denial and audit activities for timely responses to denials and audit requests for institutional and professional claims.
• Assisting with coordination of denial and review materials for committee meetings.
• Communicating with stakeholders and monitoring day-to-day denials and audit reviews.
• Maintaining the healthcare tracking tool that stores denial and review activity, including access management and training.
• Supporting Denials Management projects, including meetings, research, audits, data analysis, and documentation.
• Strong communication and commitment to high-quality work.

Skills

Analytical skills

Communication skills

Excel

Attention to detail

Revenue Cycle knowledge

Education

Bachelor's degree or equivalent

Tools

Epic PB Resolute

Epic Certification

CRCR Certification

Job description

Shriners Children's is seeking a Denials Management Analyst to analyze denials data, track payor metrics, and coordinate denial and audit activities across multiple systems, including Epic PB Resolute. The role supports root-cause analysis and process improvement to ensure timely responses for all payor denials and appeals.

The position requires 5–7 years in healthcare revenue cycle with Epic PB Resolute experience, strong communication, and intermediate Excel skills.