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About the Role

The Professional Billing Specialist (Anesthesia) is responsible for managing all professional billing requirements and accounts receivable tasks according to standard and productivity measurements, ensuring compliance with all regulatory and payor guidelines.

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.
• Review all denial accounts for categorization, level of appeal, and special requirements for initiating appeals.
• Communicate global payer issues with the payer relations team.
• Communicate and coordinate with various individuals/distributions and assist with monitoring day-to-day activities related to appeal follow-up and denials.
• Maintain the healthcare tracking tool/application that stores/communicates claim edits, review, and denial activity, including user access management, software updates, and end-user training.
• 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 outcomes, collecting/analyzing, reporting status, metrics, and trends of activity by different reviews from the tool, and distributing reports routinely.
• 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 Billing and Denials Management teams, which may include coordinating meetings, conducting research for payor criteria, and preparing documents.
• Build and maintain relationships with payer representatives.

Requirements

• 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 specific billing and payment standards for hospital services
• Thorough understanding of managed care payment methodologies and principles
• Certification in Epic PB Resolute or agreement to obtain certification within 12 months after hire
• Bachelor’s Degree or equivalent combination of education and experience

Skills

• Epic PB Resolute
• Anesthesia billing
• Healthcare Revenue Cycle
• Third Party Collection/AR Receivables
• EDI Transaction sets (837P)
• Insurance contract rate analysis
• Registration and Collections processes
• Government and Managed Care billing rules
• Payor 835 and EOB analysis
• CCI edits, CPT, HCPCS, ICD-10, Revenue Codes
• Excel (Intermediate)
• Spreadsheet applications
• Database applications
• Managed care patient financial systems
• Managed care payment methodologies
• SQL
• Crystal Reports

Location

• Remote

Work Type

• Full-time

Experience Level

• 5 years' experience in a Healthcare/Hospital Revenue Cycle Environment
• 3 years of related Anesthesia experience

Education Level

• Bachelor’s Degree or equivalent combination of education and experience

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.
• Engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact.
• Fosters a learning environment that values evidenced based practice, experience, innovation, and critical thinking.
• Compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for 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.