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About the Role

The Denials Management Analyst is responsible for analyzing denials data, creating payor metrics, and tracking/trending denials from multiple systems. This role identifies root causes, reports findings, and assists in process improvement mapping. The analyst will coordinate payor denials and audit activities, ensuring timely responses for claims, audits, and appeals, while communicating with various stakeholders and monitoring daily claim denial and audit review activities.

Responsibilities

Collect, analyze, and report status, metrics, and trends of activity by different reviews from multiple systems.
Distribute reports on a routine basis to specific distribution groups.
Manage Epic work queues and resolve denials.
Gather data to substantiate requests for rule creations in Epic.
Research payer fee schedules and provider manuals to ensure appropriate non-covered denials.
Organize all data and activity in a retrievable way.
Coordinate payor denial and audit activities to ensure timely response for the processing of all payor denials, audit requests, and appeals for both institutional and professional claims.
Assist with the coordination of denial and review activities and materials for committee meetings, including analyses and reports.
Communicate and coordinate with various individuals/distributions and assist with monitoring of the day-to-day activities related to claim denials and audit reviews.
Maintain the healthcare tracking tool/application that stores/communicates all denial and review activity, including user access management, software updates, and end-user training.
Support projects and initiatives of the Denials Management Team, which may include coordinating meetings, conducting research, performing audits or data analysis, and preparing documents.

Requirements

Bachelor's degree, or equivalent combination of education and experience.
5-7 Years in a Healthcare Revenue Cycle Environment.
3 years in Third Party Collection/AR Receivables and Denials Management.
Epic PB Resolute experience.
Healthcare Revenue Cycle management including Therapy (Physical/Occupational/Speech), Radiology, Pediatrics/Pediatric Orthopedics, and Anesthesia.
Experience with 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.

Skills

Strong communication skills
Commitment to delivering the highest level of quality work
Epic PB Resolute experience
Healthcare Revenue Cycle management
EDI Transaction sets
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

Experience Level

5-7 Years in a Healthcare Revenue Cycle Environment
3 years in Third Party Collection/AR Receivables and Denials Management

Education Level

Bachelor's degree
Equivalent combination of education and experience

Salary/Compensations

$66,872.00 - $100,318.40

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 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.