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About the Role

The Denials Management Follow Up Representative is responsible for following up on payor responses to Shriners Children's submitted appeals. The Representative will contact insurance carriers to ensure timely payment and collection of money due to the Shriners Children's organization after the appeals process has successfully taken place.

Responsibilities

• Coordinate 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 for both institutional and professional claims.
• Communicate and coordinate with various individuals/distributions and assist with monitoring of the day to day activities related to appeal follow up and denials.
• Maintain the hospital tracking tool/application that stores/communicates all denial and review activity, including user access management, software updates, and end-user training.
• Collect and analyze data, report status, metrics, and trends of activity by different reviews from multiple systems, developing routine reports for specific distribution groups.
• Organize all data and activity in a retrievable way to ensure timely follow up on appeals to third party payors.
• Assist with the coordination of denial and review activities and materials for committee meetings, including analyses and reports.
• Support projects and initiatives of the Revenue Integrity team, which may include coordinating meetings, conducting research for payor criteria, and preparing documents.
• Demonstrate strong communication skills and a commitment to delivering the highest level of quality work.

Requirements

• 5-7 Years in a healthcare patient accounting revenue cycle environment
• Knowledge of Hospital Revenue Cycle revenue management EDI Transaction sets including 837I, 837P 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
• Experience with Epic EMR (HB and/or PB)
• Bachelor's Degree or equivalent combination of education and experience

Skills

• Communication skills

Experience Level

• 3 years in Hospital Third Party Collection/AR Receivables

Education Level

• Bachelor's Degree

Salary/Compensations

• $24.16 - $36.24

About the Company

• 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.