Denials Management Follow Up Representative

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

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 for both institutional and professional claims; 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 hospital tracking tool/application that stores/communicates all denial and review activity, including user access management, updates to software, and end-user training; Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems and developing routine reports to specific distribution groups; 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 and reports; Supporting projects and initiatives of the Revenue Integrity team, including coordinating meetings, conducting research for payor criteria, and preparing documents; Strong communication skills and a commitment to delivering the highest level of quality work

Requirements

5-7 Years in a healthcare patient accounting revenue cycle environment; Knowledge of Hospital Revenue Cycle revenue management EDI Transaction sets including 837I, 837P 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; Epic EMR (HB and/or PB); Bachelor's Degree or equivalent combination of education and experience in lieu of degree

Nice to have

3 years in Hospital Third Party Collection/AR Receivables