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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.

All employees are eligible for medical coverage on their first day! In addition, 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. Benefits may vary based on state law.

The Hospital Billing Denials Analyst is responsible for proactively analyzing pre-billing payer rejections, as well as billing denials data, creating metrics, as well as tracking and trending denials that occur due to payer billing requirements. 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 analyze Key Performance Indicator (KPI) data and coordinate revenue cycle analytics for the hospital billing team, utilizing available data, as well as quantify expected revenue impact and other characteristics supporting prioritization decisions.

• Monitor and analyze billing denials
  • Independently identify billing denial reason trends
  • Provide improvement recommendations
  • Research and keep current on payer billing requirements for all federal, state and third-party payers
  • Submit rebills as appropriate, or route to CBO for follow-up and/or write off
  • Prioritize activities to alleviate untimely filing
• Create metrics, as well as tracking and trending denials that occur due to payer billing requirements
  • Identify denial reasons and report out findings, as well as, assist in mapping out process improvement opportunities.
• Ensure accurate processing of claims in a manner that is consistent with industry standards, regulations, and SHC policies and procedures.
• Document all communications with payers, as well as all billing activities, on the patient’s account with clear, concise, and accurate comments
• Consistently seek improvement in processes and procedures for all billing and reimbursement functions, to include workflow, and billing issues.
• Support projects and initiatives.
  • Conduct research for payer criteria, and prepare documents for resubmission or special projects
• Build and maintain relationships with payer representatives
• Crosstrain in multiple areas, as well as perform all other duties as assigned

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.

Required:

• 3-5 years of experience in medical billing, to include all EDI Transaction sets, UB04 and 1500 claim form
• Possess expert knowledge in federal, state and third-party claims’ processing practices
  
• Maintain expertise regarding CCI edits, HCPCS, ICD-10, and Revenue Codes
• High School Diploma/GED

Preferred:

• 3-5 years of experience in insurance claims' processing and follow-up
  
• Epic experience
  
• Bachelor's degree or equivalent combination of education, training and experience