Shriners Children's

Billing Specialist

Shriners Children's

full-time

Posted on:

Location Type: Remote

Location: United States

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About the role

  • Managing all professional billing requirements and managing accounts receivable tasks according to standard and productivity measurements.
  • Ensure all regulatory and payor guidelines are followed.
  • 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.
  • 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.
  • 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.

Requirements

  • 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.
Benefits
  • All employees are eligible for medical coverage on their first day!
  • Upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service.
  • Employees in a FT or PT status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans and a Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected.
  • Additional benefits available to FT and PT employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans.

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
Epic PB ResoluteHealthcare Revenue Cycle managementEDI Transaction sets837PCPTHCPCSICD-10Revenue CodesIntermediate ExcelDatabase applications
Soft skills
CommunicationCoordinationRelationship buildingOrganizational skillsAnalytical skillsMonitoringReportingAssistingTimely follow-upResearch
Certifications
Certification in Epic PB ResoluteBachelor's Degree