Denials Management Appeals Nurse (Anesthesia)

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 The Denials Management Appeals Nurse (Anesthesia) is responsible for managing our medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.

The Denials Management Appeals Nurse (Anesthesia) will utilize their clinical background to address the clinical denials, as well as write sound, compelling factual arguments for appealing denials.

The Denials Management Appeals Nurse (Anesthesia) is also responsible for maintaining a detailed knowledge of Third Party Payors and Governmental Payors clinical/medical necessity criteria, as well as filing compliant appeals in accordance with Third party and governmental contracts.

Responsibilities Performs a review of assigned cases comparing the bill to the medical record.

Performs a detailed comparison of charges to documentation to ensure services documented have been captured through the charge process Performs a detailed comparison of charges to documentation to ensure services not documented are not charged.

Reviews documentation to ensure that services typically performed with specific procedures are being documented so that charge capture may occur Review findings with the hospital representatives and obtains an agreement on the discrepancies.