Authorization Denials Representative

Shriners Children's

1d•Remote

About The Position

The Authorization Denials Representative is responsible for following up on payor responses to SHC submitted appeals. They will contact insurance carriers to ensure timely payment and collection of money due to the SHC organization after the appeals process has successfully taken place. The representative will verify that concurrent review medical records have been received by the payer and will communicate with Utilization Review if records are not on file.

Requirements

1-3 years of healthcare revenue cycle experience
Knowledge of Healthcare Revenue Cycle revenue management
Knowledge of transaction sets including 837I, 837P, 835 and EOB responses
Knowledge of insurance contract rates and terms
Knowledge of registration and authorization processes
Knowledge of government and managed care billing, coverage, authorization and payment rules
High School Diploma/GED

Nice To Haves

Epic EMR experience
Knowledge of SQL or Crystal Reports
Bachelor's degree

Responsibilities

Coordinates payer denial and appeal follow up activities to ensure appeals are on file and are being processed by the third-party payer, to include ensuring the payer has all documentation required to process the appeal.
Maintains 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 to support all follow up activities.
Collects/analyzes report status, metrics and trends of activity by different reviews from the tool. Distributes reports on a routine basis to specific distribution groups.
Organizes all data and activity in a retrievable way to ensure timely follow up on appeals to third party payors.
Assists with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc.
Supports projects and initiatives of the Authorization Denials Management team. This may include coordinating meetings, conducting research for payer criteria, and preparing documents.
Verifies concurrent review medical records have been received by the third-party payer and communicates with UR if additional submission is required.
This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned.

Benefits

medical coverage on their first day
403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service
paid time off
life insurance
short term and long-term disability
Flexible Spending Account (FSA) plans
Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected
tuition reimbursement
home & auto
hospitalization
critical illness
pet insurance