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Resolution Analyst, Denials (REMOTE)

1 week, 5 days ago
United States
Full-time
Senior
Accountant
Customer and Technical Support
Apply Now
EnableComp

EnableComp

EnableComp specializes in complex claims and specialty revenue cycle management solutions for healthcare providers, focusing on optimizing reimbursements for various claims types, including VA, Workers' Compensation, and Motor Vehicle Accidents, throug...

Insurance
251-1K
Founded 2000
View All Jobs 10

Description

  • Review, evaluate, appeal, and follow up on denied, underpaid, and other assigned claims using proprietary software and tools.
  • Use payer payment documentation and provider contract information to determine the correct reimbursement amount.
  • Review hospital contracts to identify underpayments and recover cash payments from insurance companies.
  • Research, request, and collect medical records and supporting documentation for complex underpayment appeals.
  • Prepare and submit appeals to the appropriate payer in a timely and accurate manner.
  • Conduct follow-up calls with payers to confirm receipt of documentation and resolve outstanding receivables.
  • Maintain confidentiality and strict privacy and security standards for PHI and other sensitive information.
  • Support smooth operations and customer satisfaction while completing other assigned duties.

Requirements

  • High school diploma or GED required; associate’s or bachelor’s degree preferred.
  • 5+ years of experience in the healthcare field working in billing or collections.
  • 1+ years of client-facing or customer service experience.
  • Intermediate understanding of insurance payer/provider claims processing and related data requirements.
  • Strong computer proficiency, including MS Office Word, Excel, and Outlook.
  • Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.
  • Strong understanding of the revenue cycle process and hospital reimbursement.
  • Intermediate knowledge of managed care contracts, contract language, and federal and state requirements.
  • Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims.
  • Intermediate understanding of EOBs, UB04 hospital billing forms, and HCFA 1500 forms.
  • Ability to review client and payer contracts to identify complex underpayments.
  • Regular and predictable attendance required.
  • Equivalent combination of education and experience will be considered.
  • Must be able to perform the essential duties satisfactorily, with reasonable accommodations available for qualified individuals with disabilities.
  • Must be a self-starter able to work independently without direct supervision.
  • Strong written and verbal communication skills, analytical skills, and problem-solving skills.
  • Ability to prioritize and manage multiple competing priorities and projects concurrently.
  • Proven ability to meet or exceed productivity targets and goals.
  • Ability to remain stationary for 50% of the time and operate computer and office equipment consistently.

Benefits

  • Work for a multi-year Top Workplaces award recipient and a recognized industry leader.
  • Opportunity to join a company committed to professional growth and development.
  • Supportive culture that invests in employees with tools, resources, and career support.
  • Flexible, family-oriented work environment with work-life balance emphasized.
  • Equal Opportunity Employer with a commitment to a discrimination- and harassment-free workplace.

Interested in this position?

Apply directly on the company website

Apply Now

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