Denials Management Follow Up Representative

Company Overview

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.

All employees are eligible for medical coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403(b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a FT or PT status (40+ hours per pay period) will also be 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. Additional benefits available to FT and PT employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law.

Job Overview

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

• Coordinating 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.
• Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day to day activities related to appeal follow up and denials.
• Maintaining the hospital tracking tool/application that stores/communicates all denial and review activity. This will include user access management, updates to software, and end-user training to support all follow-up activities.
• Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems. Developing reports on a routine basis to specific distribution group.
• Organizing all data and activity in a retrievable way to ensure timely follow up on appeals to third party payors.
• Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc.
• Supporting projects and initiatives of the Revenue Integrity team. This may include coordinating meetings, conducting research for payor criteria, and preparing documents.
• Strong communication skills and a commitment to delivering the highest level of quality work.

This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned.

Qualifications

Required:

• 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
• Epic EMR (HB and/or PB)
• Bachelor's Degree or equivalent combination of education and experience in lieu of degree

Preferred:

• 3 years in Hospital Third Party Collection/AR Receivables