Shriners Children’s is a pediatric specialty healthcare organization focused on patient care, education, and research. This role supports professional billing for anesthesia services and manages accounts receivable tasks in accordance with productivity standards and regulatory and payer guidelines.
Key responsibilities include:
- Coordinating payer denial and appeal follow-up to support timely responses and processing of denials, documentation requests, and appeals
- Reviewing denial accounts for categorization, appeal level, and special requirements
- Communicating global payer issues with the payer relations team
- Monitoring appeal follow-up and denial workflows on a day-to-day basis
- Maintaining the healthcare tracking tool/application used to store and communicate claim edits, review activity, and denial activity
- Managing user access, software updates, and end-user training related to follow-up workflows
- Monitoring claim edit and denial management work queues to ensure resolution
- Ensuring medical records requests are completed and submitted within 48 hours
- Tracking denials in a database and reporting outcomes, metrics, and trends
- Organizing appeal activity and related materials for committee meetings
- Supporting billing and denials management projects and initiatives
- Building and maintaining relationships with payer representatives
Requirements & Qualifications
- Epic PB Resolute experience
- 3 years of related anesthesia experience
- 5 years of experience in a healthcare/hospital revenue cycle environment, including third-party collections and accounts receivable
- Experience with healthcare revenue cycle 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 understand 835 remittance advice and paper EOB responses
- Understanding of CCI edits, CPT, HCPCS, ICD-10, and revenue codes
- Intermediate Excel skills
- Strong computer skills, including spreadsheet and database applications
- Knowledge of managed care patient financial systems and hospital billing/payment standards
- Strong understanding of managed care payment methodologies
- Epic PB Resolute certification or agreement to obtain certification within 12 months of hire
- Bachelor’s degree or equivalent combination of education and experience
- Preferred: knowledge of SQL or Crystal Reports
- Preferred: HFMA CRCR credential
Benefits & Perks
- Medical coverage starting on day one
- 403(b) and Roth 403(b) retirement plan with up to 6% matching contributions after one year of service
- Paid time off for full-time and part-time employees working 40+ hours per pay period
- Life insurance
- Short-term and long-term disability coverage
- Flexible Spending Account (FSA)
- Health Savings Account (HSA) if a High Deductible Health Plan is elected
- Tuition reimbursement
- Home and auto insurance options
- Hospitalization insurance
- Critical illness insurance
- Pet insurance
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 week ago
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