Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

Location

Job Description

General Summary:

The Revenue Cycle Professional Billing Denials Analyst is responsible for analyzing, tracking, and resolving professional billing claim denials to optimize reimbursement and minimize revenue leakage. This role collaborates closely with coding, billing, payer relations, and clinical departments to identify denial trends, recommend process improvements, and support appeal strategies. The ideal candidate possesses strong analytical skills, healthcare billing knowledge, and a proactive approach to denial prevention and resolution. 

Essential Job Functions:

Denial Management & Resolution 

Review and resolve professional billing denials in Epic workqueues and payer portals. 

Analyze denials by category (e.g., coding, authorization, eligibility, bundling) to determine root cause and appropriate resolution pathway. 

Work collaboratively with clinical departments, coders, and payers to ensure timely appeal submissions. 

Prepare and submit appeals with supporting clinical documentation and justifications. 

Escalate complex denials requiring payer intervention or legal review. 

Data Analysis & Reporting 

Monitor denial trends and produce routine and ad hoc reports to identify patterns. 

Track key denial KPIs such as first pass denial rate, overturn rate, and appeal success rate. 

Analyze financial impacts of denials on revenue. 

Identify and prioritize denials based on financial risk or impact. 

Provide actionable insights to improve front-end processes and reduce preventable denials. 

Process Improvement 

Participate in denial prevention initiatives, including front-end and back-end education, edit refinements, and payer policy reviews. 

Recommend changes to workflows, system configurations, or documentation practices based on analysis findings. 

Contribute to root cause analysis (RCA) sessions and collaborate on corrective action plans. 

Payer Relations & Compliance 

Maintain up-to-date knowledge of payer guidelines, coverage policies, and industry regulations. 

Communicate denial trends and appeal outcomes with payer representatives during monthly meetings. 

Ensure all activities comply with HIPAA, CMS, and internal audit standards. 

Required: 

Associate's degree in healthcare administration, Business, or related field; or equivalent work experience. 

Minimum 3 years of experience in revenue cycle operations with a focus on denials management. 

Strong knowledge of CPT, ICD-10, and HCPCS codes. 

Understanding of payer policies and regulations (Medicare, Medicaid, commercial insurances). 

Strong analytical and problem-solving skills. 

Proficiency with Epic Resolute Professional Billing and Microsoft Excel. 

Education

Pay Range

At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children’s offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs. For more details on other compensation, consult your recruiter or click the following link to learn more about our benefits.

Benefit Statement

For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:

Medical, dental and vision insurance

Employer paid group term life and disability

Employer contribution toward Health Savings Account

Flexible Spending Accounts

Paid Time Off (PTO), Paid Holidays and Paid Parental Leave

403(b) with a 5% employer match

Various voluntary benefits:

Supplemental Life, AD&D and Disability

Critical Illness, Accident and Hospital Indemnity coverage

Tuition assistance

Student loan servicing and support

Adoption benefits

Backup Childcare and Eldercare

Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members

Discount on services at Lurie Children’s facilities

Discount purchasing program

There’s a Place for You with Us

At Lurie Children’s, we embrace and celebrate building a team with a variety of backgrounds, skills, and viewpoints — recognizing that different life experiences strengthen our workplace and the care we provide to the Chicago community and beyond. We treat everyone fairly, appreciate differences, and make meaningful connections that foster belonging. This is a place where you can be your best, so we can give our best to the patients and families who trust us with their care.  

Lurie Children’s and its affiliates are equal employment opportunity employers.  All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, pregnancy, protected veteran status, order of protection status, protected genetic information, or any other characteristic protected by law.

Support email: candidatesupport@luriechildrens.org