Revenue Analyst, Rehab & Therapy Services

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. 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. Job Overview 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.

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

Qualifications

Required 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 Preferred 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 Apply To This Job