拒付管理分析师
Denials Management Analyst
公司简介
Shriners Children’s 是一个尊重、支持和重视每个人的组织。被《福布斯》评为 2025 年最佳中型企业雇主，我们致力于提供卓越的患者护理，拥抱具有全球影响力的多学科教育和研究。我们营造一个以循证实践、经验、创新和批判性思维为价值的学习环境。我们的同理心、诚信、责任感和韧性定义了我们在儿童专科护理领域的领导地位，为孩子们及其家庭服务。
我们在全球拥有 20 多家医院、门诊诊所、日间护理中心和外展地点，无论家庭是否有支付能力或保险状况，我们都为 18 岁以下的儿童提供优质的护理。请点击此处了解我们的更多地点信息。
现任员工：请登录 Workday 点击此处通过“Jobs Hub”内部申请
职位描述
拒绝管理分析师负责分析拒绝数据，创建付款人指标，并从多个系统中跟踪和分析拒绝情况及结果。该分析师将识别并分析根本原因，报告发现结果，并协助制定流程改进机会。该分析师将协调付款人拒绝和审计活动，确保及时处理所有付款人拒绝、审计请求和上诉。该分析师将与各种个人/部门沟通协调，并协助监控与索赔拒绝和审计审查相关的日常活动。
主要职责
- 从多个系统中收集/分析数据，报告不同评审的状况、指标和趋势，定期向特定分发组分发报告
- 管理 Epic 工作队列并解决拒绝问题
- 收集数据以支持 Epic 中规则创建的请求
- 研究付款人费用表和供应商手册，确保适当的非覆盖拒绝
- 以可检索的方式整理所有数据和活动，协调付款人拒绝和审计活动，确保及时处理所有付款人拒绝、审计请求和上诉，包括机构和专业索赔
- 协助协调拒绝和审查活动及相关材料，用于委员会会议，包括分析、报告等
- 与各种个人/部门沟通协调，并协助
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Company Overview
Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, 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 define us as leaders in pediatric specialty care for our children and their families.
With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family’s ability to pay or insurance status. Please click here to learn more about our locations.
CURRENT EMPLOYEES: Please log into Workday Click Here to apply internally through the "Jobs Hub"
Job Description
The Denials Management Analyst is responsible for analyzing denials data, creating payor metrics, as well as tracking and trending denials and result out of multiple systems. The analyst will identify and trend root causes and report out findings as well as assist in mapping out process improvement opportunities. The Analyst will coordinate payor denials and audit activities to ensure timely response for the processing of all payor denials, audit requests and appeals. The Analyst will communicate and coordinate with various individuals/distributions and assist with monitoring of the day-to-day activities related to claims denials and audit reviews.
Key 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
Required Qualifications:
- Bachelor's degree, or equivalent combination of education and experience
- 5-7 Years in a Healthcare Revenue Cycle Environment including 3 years in Third Party Collection/AR Receivables and Denials Management
- Epic PB Resolute experience
- Healthcare Revenue Cycle management including:
• Therapy (Physical/Occupational/Speech)
• Radiology
• Pediatrics/Pediatric Orthopedics
• Anesthesia
- EDI Transaction sets including 837I, 837P
- Knowledge of insurance contract rates and terms
- Knowledge and understanding of Registration and Collections
- Knowledge and understanding of Government and Managed Care billing, coverage and payment rules
- Ability to comprehend payor 835 and paper EOB responses
- Knowledge and understanding of NCCI edits, CPT-4, HCPCS, ICD-10 and Revenue Codes standards
- Intermediate Excel skills
Preferred Qualifications:
- CRCR Certification
- Epic Certification
Compensation is determined based on years of relevant experience and departmental equity.Originally posted on Himalayas