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Shriners Children's · 1 month ago

Denials Management Analyst

United States

Full-time

Remote

Senior Level

5+ years exp

Shriners Children’s is an organization dedicated to providing excellence in patient care and multi-disciplinary education. The Denials Management Analyst is responsible for analyzing denials data, creating payor metrics, tracking and trending denials, and coordinating audit activities to ensure timely responses for payor denials and appeals.

Child CareHealth CareHealth DiagnosticsMedicalNon Profit

Responsibilities

Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems Distributing reports on a routine basis to specific distribution group

Managing Epic work queues and resolving denials

Gathering data to substantiate the request for rule creations in Epic

Research payer fee schedules and provider manuals to ensure appropriate non covered denials

Organizing all data and activity in a retrievable way Coordinating payor denial and audit activities to ensure timely response for the processing of all payor denials, audit request and appeals for both institutional and professional claims

Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc

Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities related to claim denials and audit reviews

Maintaining the healthcare tracking tool/application that stores/communicates all denial and review activity. This will include user access management, updates to software, and end-user training

Supporting projects and initiatives of the Denials Management Team. This may include coordinating meetings, conducting research, performing audits or data analysis, and preparing documents

Strong communication skills and a commitment to delivering the highest level of quality work

Qualification

Epic PB ResoluteHealthcare Revenue CycleEDI Transaction setsCRCR CertificationExcelInsurance contractsGovernment billingNCCI editsData analysisProcess improvementCommunication skills