Revenue Analyst, Rehab & Therapy Services

Shriners Children's•Remote,

1d•Onsite

About The Position

Shriners Children's is the premier pediatric burn, orthopaedic, spinal cord injury, cleft lip and palate, and pediatric subspecialties medical center. We have an opportunity for a Revenue Analyst, Rehab & Therapy Services reporting into our Corporate Headquarters location. The Revenue Analyst, Rehab and Therapy Services is responsible for analyzing denials data, creating metrics, as well as tracking and trending denials and results for the Central Auth Unit with specific emphasis on Rehab and Therapy Services. The Analyst will perform appeals, and correct bill hold edits, as appropriate. The Analyst will identify and trend root causes and report out findings, as well as, assist in mapping out process improvement opportunities. Works as a vital team member with the CAU and with the Rehab, Therapy Services Department in identifying intervention points to increase reimbursement and reduce denials specific to Rehab and Therapy Services. The Analyst will coordinate payor denials and audit activities to ensure timely response for the processing of all payor denials, and appeals. The Analyst will communicate and coordinate with various individuals/distributions and assist with monitoring of the day-to-day activities related to CAU claims denials and edits. The Analyst will participate in internal and SHC system-wide revenue cycle meetings designed to improve revenue cycle processes. The Analyst will analyze KPI data and coordinate revenue cycle analytics for the CAU, utilizing available data, as well as quantify expected revenue impact and other characteristics supporting prioritization decisions, as it relates to the CAU.

Requirements

High School Diploma/GED
Demonstrated experience in Rehab, Therapy Services revenue cycle
5 years of Insurance authorization/eligibility disputes/denials
Expert health insurance knowledge, types of plans.
Understanding of insurance verification, eligibility, coverage, benefits, and authorization.
Strong communication, critical thinking, and problem-solving skills.
Strong analytical and problem solving skills

Nice To Haves

Bachelor's degree, Experience greater than the minimum required years may be considered in lieu of Bachelor's degree.
Effective interpersonal and communication skills
Exhibits competency in the use of computer software: Microsoft Word, Excel
Knowledge of Cerner Millennium
Knowledge of EPIC

Responsibilities

Monitoring authorization and eligibility denials, and resolutions from participating insurance carriers
Submitting appeals as appropriate, or routing to CBO for follow-up and/or write off
Working with CAU and Rehab, Therapy leadership to proactively avoid recurrent denials
Independently identifying authorization, and eligibility denial reason trends, and providing improvement recommendations
Providing decision making in determining what criteria to apply in developing process improvement based upon denial information.
Creating the protocols to follow to prevent future denials
Providing training to the CAU and other facilities based upon new protocols
Working closely and professionally with outside agencies on authorization and eligibility denials avoidance and processing
Working CAU billing edits, as well as assisting with bill edits for open RCM positions or locations transitioning to a new delivery model, or serving as a backup or regional assistance.
Performing continuous deep-dive analysis

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