Company Overview #LI-Remote 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 The Denials Management Follow Up Representative is responsible for following up on payor responses to Shriners Children's submitted appeals. The Representative will contact insurance carriers to ensure timely payment and collection of money due to the Shriners Children's organization after the appeals process has successfully taken place. Responsibilities - 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 for both institutional and professional claims. - 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 hospital 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. - Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems. Developing 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 Revenue Integrity team. This may include coordinating meetings, conducting research for payor criteria, and preparing documents. - Strong communication skills and a commitment to delivering the highest level of quality work. 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. Qualifications Required: - 5-7 Years in a healthcare patient accounting revenue cycle environment - Knowledge of Hospital Revenue Cycle revenue management EDI Transaction sets including 837I, 837P 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-9 and Revenue Codes - Bachelor's Degree or equivalent combination of education and experience in lieu of degree Preferred: - 3 years in Hospital Third Party Collection/AR Receivables

Employment Type: Full timeShift: Day Shift Description: POSITION PURPOSE Work Remote Position (Pay Range: $19.2123-$28.8184) Performs day- to- day customer service activities within the hospital revenue operations of an assigned Patient Business Services (PBS) location. Serves as part of a Customer Service team at an assigned PBS location responsible for ensuring excellent customer satisfaction through timely, accurate and professional follow-up and resolution to customer complaints, problems, issues and general inquiries. This position reports to the Supervisor PFS Customer Service. ESSENTIAL FUNCTIONS Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Performs customer service activities handling various self-pay and insurance billing and collection inquiries, requests and related functions as part of the revenue cycle process for an assigned PBS location. Assists patients in the resolution of billing issues, which may include setting up payment plans and responding to complaints, problems and general inquiries in a timely, responsive and efficient manner. Provides detailed documentation and reports of customer complaints, issues, interactions, actions taken and results in appropriate system(s). Tracks trends of customer service encounters and recommendations for resolutions of the issues and findings for the supervisor. Resolves independently or escalates issues affecting customer complaints and issues to the Supervisor Customer Service. Performs communication and follow-up processes related customer service and ensures such activities are submitted timely, tracked, trended and reported to key stakeholders. Performs other duties as needed and assigned by the supervisor. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. MINIMUM QUALIFICATIONS High school diploma or Associate's degree in Accounting or Business Administration or related field, and at least one (1) year of experience and relevant knowledge of revenue cycle functions and systems working within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer service activities or an equivalent combination of education and experience. Experience in a complex, multi-site environment preferred. Previous service/call center experience with the ability to respond to customer inquiries and expectations in a highly efficient and effective manner. Excellent verbal and written communication skills and organizational abilities. Strong interpersonal skills in interacting with internal and external customers, which includes the ability to interpret customer requirements and recommending appropriate actions to satisfy customer needs. Accuracy, attention to detail and time management skills. Ability to work independently and operate keyboard and telephone effectively. Basic understanding of Microsoft Office, including Outlook, Word, PowerPoint, and Excel. Completion of regulatory/mandatory certifications and skills validation competencies preferred Must be comfortable operating in a collaborative, shared leadership environment. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health. Bilingual in English and Spanish highly desirable PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS This position operates in a typical office environment. The area is well lit, temperature controlled and free from hazards. Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues. Manual dexterity is needed in order to operate a keyboard. Hearing is needed for extensive telephone and in person communication. The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions. Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Must possess the ability to comply with Trinity Health policies and procedures. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Employment Type: Full timeShift: Day Shift Description: POSITION PURPOSE Work Remote Position (Pay Range: $19.2123-$28.8184) Performs day- to- day customer service activities within the hospital revenue operations of an assigned Patient Business Services (PBS) location. Serves as part of a Customer Service team at an assigned PBS location responsible for ensuring excellent customer satisfaction through timely, accurate and professional follow-up and resolution to customer complaints, problems, issues and general inquiries. This position reports to the Supervisor PFS Customer Service. ESSENTIAL FUNCTIONS Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Performs customer service activities handling various self-pay and insurance billing and collection inquiries, requests and related functions as part of the revenue cycle process for an assigned PBS location. Assists patients in the resolution of billing issues, which may include setting up payment plans and responding to complaints, problems and general inquiries in a timely, responsive and efficient manner. Provides detailed documentation and reports of customer complaints, issues, interactions, actions taken and results in appropriate system(s). Tracks trends of customer service encounters and recommendations for resolutions of the issues and findings for the supervisor. Resolves independently or escalates issues affecting customer complaints and issues to the Supervisor Customer Service. Performs communication and follow-up processes related customer service and ensures such activities are submitted timely, tracked, trended and reported to key stakeholders. Performs other duties as needed and assigned by the supervisor. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. MINIMUM QUALIFICATIONS High school diploma or Associate's degree in Accounting or Business Administration or related field, and at least one (1) year of experience and relevant knowledge of revenue cycle functions and systems working within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer service activities or an equivalent combination of education and experience. Experience in a complex, multi-site environment preferred. Previous service/call center experience with the ability to respond to customer inquiries and expectations in a highly efficient and effective manner. Excellent verbal and written communication skills and organizational abilities. Strong interpersonal skills in interacting with internal and external customers, which includes the ability to interpret customer requirements and recommending appropriate actions to satisfy customer needs. Accuracy, attention to detail and time management skills. Ability to work independently and operate keyboard and telephone effectively. Basic understanding of Microsoft Office, including Outlook, Word, PowerPoint, and Excel. Completion of regulatory/mandatory certifications and skills validation competencies preferred Must be comfortable operating in a collaborative, shared leadership environment. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS This position operates in a typical office environment. The area is well lit, temperature controlled and free from hazards. Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues. Manual dexterity is needed in order to operate a keyboard. Hearing is needed for extensive telephone and in person communication. The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions. Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Must possess the ability to comply with Trinity Health policies and procedures. The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

• Performs day-to-day customer service activities within the hospital revenue operations of an assigned Patient Business Services (PBS) location • Serves as part of a Customer Service team at an assigned PBS location responsible for ensuring excellent customer satisfaction through timely, accurate and professional follow-up and resolution to customer complaints, problems, issues and general inquiries • Reports to the Supervisor PFS Customer Service • Assists patients in the resolution of billing issues, which may include setting up payment plans and responding to complaints, problems and general inquiries in a timely, responsive and efficient manner • Provides detailed documentation and reports of customer complaints, issues, interactions, actions taken and results in appropriate system(s) • Tracks trends of customer service encounters and recommendations for resolutions of the issues and findings for the supervisor • Resolves independently or escalates issues affecting customer complaints and issues to the Supervisor Customer Service • Performs communication and follow-up processes related customer service and ensures such activities are submitted timely, tracked, trended and reported to key stakeholders • Performs other duties as needed and assigned by the supervisor • Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.