Denials Management Follow Up Representative

Company Overview:
#LI-Remote

Shriners Children’s is a family that respects, supports, and values each other. 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 defines us as leaders in pediatric specialty care for our children and their families.

Job Overview:
Shriners Children's is the premier pediatric burn, orthopaedic, spinal cord injury, cleft lip and palate, and pediatric subspecialties medical center. We have an opportunity for a remote Denials Management Follow Up Representative reporting into our Corporate Headquarters. Do you have healthcare patient accounting and healthcare appeals and denials experience, and would you like to use that experience to serve Shriners' mission of providing quality care to our pediatric patients and their families? Then this position may be for you!

The Denials Management Follow Up Representative is responsible for following up on payor responses to Shriners Children's (SHC) submitted appeals. The Representative will contact insurance carriers to ensure timely payment and collection of money due to the SHC organization after the appeals process has successfully taken place.

Responsibilities:
Responsibilities include 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 appeal; as well as communicating and coordinating with various individuals/distributions and assisting with monitoring of the day to day activities related to appeal follow up and denials.

Qualifications:
Requirements for this position include 5 yrs in healthcare patient accounting revenue cycle environment. A Bachelor's Degree, or equivalent combination of education and experience, is required. 3 years of Hospital Third Party Collection / AR Receivables is preferred in this role. Key knowledge and skills for this role are hospital revenue cycle revenue management, EDI Transaction sets including 837I, 837P; insurance contract rates and terms; understanding of registration and collections; and the ability to comprehend payor 835 and paper EOB responses, as well CCI edits, CPT, HCPCS, ICD-9 and revenue codes.