Denials Management Follow Up Representative
公司概述：Shriners 儿童是尊重，支持和重视彼此的组织。我们被福布斯评为2025年最好的中型雇主，致力于提供患者护理卓越性，包括跨学科教育和具有全球影响力的研究。我们培养一个以证据为基础的实践，经验，创新和批判性的思维为价值的学习环境。我们的同情，诚信，责任心和弹性定义了我们作为儿童专业保健领域领导者。随着全球20多个医院，退休诊所，外科医疗中心和服务场所，我们提供优质的照顾给18岁以下儿童，无论他们的家庭支能力或保险状况如何。请点击这里了解更多关于我们的地点。当前雇员：请登录工作日 点击这里通过"就业中心"职位描述内部申请拒绝管理跟踪代表负责追踪纳税人对 Shriners 儿童提交的投诉的回应。代表将与保险公司联系，以确保在申诉过程成功后向 Shriners 儿童组织提供及时的付款和收取资金。主要责任：·协调第三方支付者及追随申请活动，并确保所有机构和职业索赔的纳税人拒绝及时回应，文件请求和呼吁处理。· 与各种个人/分销部门沟通和协调，协助监控与上诉跟踪和拒绝相关日常活动。· 维护存储/传递所有拒绝和审查活动的医院跟踪工具/应用程序。这将包括用户访问管理，软件更新以及支持所有后续活动的最终用户培训。· 从多个系统中通过不同的评论收集/分析，报告状态，指标和活动趋势；定期向特定分销组制定报告。· 将所有数据和活动进行可回收的方式组织，以确保对第三方支付者提出的呼吁及时关注。·协助协调拒绝和评估活动和委员会会议材料，包括分析，报告等。支持收入完整性团队的项目和举措。
查看英文原文
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 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.
Key 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. This will include user access management, updates to software, and end-user training to support all follow-up activities.
- Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems. Developing 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.
- Supporting projects and initiatives of the Revenue Integrity team. This may include coordinating meetings, conducting research for payor criteria, and preparing documents.
- Strong communication skills and a commitment to delivering the highest level of quality work.
Required Qualifications:
- 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
Preferred Qualifications:
· 3 years in Hospital Third Party Collection/AR Receivables
Compensation is determined based on years of relevant experience and departmental equity.Originally posted on Himalayas