Apply on Employer Site

Shriners Children's · 15 hours ago

Professional Billing Specialist

United States

Full-time

Remote

Senior Level

5+ years exp

Shriners Children’s is an organization that respects, supports, and values each other, recognized as the 2025 best mid-sized employer by Forbes. The Professional Billing Specialist is responsible for managing all professional billing requirements and accounts receivable tasks, ensuring compliance with regulatory and payor guidelines.

Child CareHealth CareHealth DiagnosticsMedicalNon Profit

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

Review all denial accounts for categorization, level of appeal, special requirements for initiating appeals

Communicate global payer issues with the payer relations team

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 healthcare tracking tool/application that stores/communicates all claim edits, review and denial activity. This will include user access management, updates to software, and end-user training to support all follow up activities

Monitor all Claim Edit and Denial Management work queues and lists to ensure they are fully resolved

Ensure medical records requests are completed and submitted within 48 hours

Track all denials on a database to determine outcome. Collecting/analyzing, report status, metrics and trends of activity by different reviews from the tool. Distributing 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

Knowledgeable about federal, state and third-party claims processing. Supporting projects and initiatives of the Billing and Denials Management teams. This may include coordinating meetings, conducting research for payor criteria, and preparing documents

Able to build and maintain relationships with payer representatives

Qualification

Epic PB Resolute experienceHealthcare Revenue Cycle managementCCI editsExcel skillsInsurance contractsGovernment billingCertification in Epic PB ResoluteComputer skillsSQLHFMA’s CRCR credential

Required

Epic PB Resolute experience

5 years' experience in a Healthcare/Hospital Revenue Cycle Environment including Third Party Collection/AR Receivables

Healthcare Revenue Cycle revenue management 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 comprehend payor 835 and paper EOB responses

Understanding of CCI edits, CPT, HCPCS, ICD-10 and Revenue Codes

Intermediate Excel skills

Excellent computer skills, especially spreadsheet and database applications

Knowledge of managed care patient financial systems and of the specific billing and payment standards utilized for services provided within a hospital setting

Thorough understanding of managed care payment methodologies and the principles of managed care

Certification in Epic PB Resolute - or agree to obtain certification within 12 months after hire

Bachelor's Degree or equivalent combination of education and experience