Shriners Children's

Bringing hope and healing to families, every day.

Denials Management Analyst

Business AnalystBusiness AnalystFull TimeRemoteTeam 10,001+Since 1922H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

61 days ago

Salary

Not specified

Bachelor Degree5 yrs expEnglish

Job Description

• Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems • Distributing reports on a routine basis to specific distribution group • Managing Epic work queues and resolving denials. • Gathering data to substantiate the request for rule creations in Epic. • Research payer fee schedules and provider manuals to ensure appropriate non covered denials. • Organizing all data and activity in a retrievable way • Coordinating payor denial and audit activities to ensure timely response for the processing of all payor denials, audit request and appeals for both institutional and professional claims • Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc. • Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities related to claim denials and audit reviews • Maintaining the healthcare tracking tool/application that stores/communicates all denial and review activity. This will include user access management, updates to software, and end-user training • Supporting projects and initiatives of the Denials Management Team. This may include coordinating meetings, conducting research, performing audits or data analysis, and preparing documents

Job Requirements

  • 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
  • Epic PB Resolute experience
  • Knowledge of healthcare Revenue Cycle management including: Therapy (Physical/Occupational/Speech), Radiology, Pediatrics/Pediatric Orthopedics, Anesthesia
  • Knowledge of EDI Transaction sets including 837I, 837P
  • Knowledge of insurance contract rates and terms
  • Knowledge and understanding of Registration and Collections
  • Knowledge and understanding of Government and Managed Care billing, coverage and payment rules
  • Ability to comprehend payor 835 and paper EOB responses
  • Knowledge and understanding of NCCI edits, CPT-4, HCPCS, ICD-10 and Revenue Codes standards
  • Intermediate Excel skills
  • Preferred: CRCR Certification
  • Preferred: Epic Certification

Benefits

  • All employees are eligible for medical coverage on their first day!
  • Eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service.
  • Eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans and a Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected.
  • Tuition reimbursement
  • Home & auto insurance
  • Hospitalization insurance
  • Critical illness insurance
  • Pet insurance
  • Much more!

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