Billing Denials Analyst

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November 19

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Shriners Children's

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Healthcare Insurance • Non-profit • Science

Shriners Children's is a non-profit organization that has been providing specialized pediatric care for over 100 years. With a commitment to excellence, their compassionate team of doctors and nurses focuses on delivering personalized care across various specialties, including burn care, orthopedics, and pediatric rehabilitation. They also engage in innovative research aimed at improving medical treatments and the overall quality of life for children.

10,000+ employees

Founded 1922

⚕️ Healthcare Insurance

🤝 Non-profit

🔬 Science

📋 Description

• Monitor and analyze billing denials • Independently identify billing denial reason trends • Provide improvement recommendations • Research and keep current on payer billing requirements for all federal, state and third-party payers • Submit rebills as appropriate, or route to CBO for follow-up and/or write off • Prioritize activities to alleviate untimely filing • Create metrics, as well as tracking and trending denials that occur due to payer billing requirements • Identify denial reasons and report out findings, as well as, assist in mapping out process improvement opportunities. • Ensure accurate processing of claims in a manner that is consistent with industry standards, regulations, and SHC policies and procedures. • Document all communications with payers, as well as all billing activities, on the patient’s account with clear, concise, and accurate comments • Consistently seek improvement in processes and procedures for all billing and reimbursement functions, to include workflow, and billing issues. • Support projects and initiatives. • Conduct research for payer criteria, and prepare documents for resubmission or special projects • Build and maintain relationships with payer representatives • Crosstrain in multiple areas, as well as perform all other duties as assigned

🎯 Requirements

• 3-5 years of experience in medical billing, to include all EDI Transaction sets, UB04 and 1500 claim form • Possess expert knowledge in federal, state and third-party claims’ processing practices • Maintain expertise regarding CCI edits, HCPCS, ICD-10, and Revenue Codes • High School Diploma/GED • 3-5 years of experience in insurance claims' processing and follow-up (Preferred) • Epic experience (Preferred) • Bachelor's degree or equivalent combination of education, training and experience (Preferred)

🏖️ Benefits

• All employees are eligible for medical coverage on their first day! • 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!