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Resolution Analyst, Denials

2 hours ago
United States
Full-time
Senior
Operations Specialist
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 outstanding, denied, underpaid, and other assigned claims using EnableComp’s proprietary tools.
  • Use payer 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 obtain medical records and supporting documentation for complex underpayment appeals.
  • Prepare and submit timely appeals to the appropriate payer to support accurate claim reimbursement.
  • Conduct telephone follow-up with payers to confirm receipt of supporting documentation and resolve outstanding receivables.
  • Serve as a liaison between key client contacts and the denials and underpayment appeal process.
  • Maintain privacy and security of PHI and confidential, proprietary information.
  • Ensure smooth operations and support customer satisfaction.
  • Perform other duties as required.

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 payors process claims.
  • Intermediate understanding of EOBs, UB-04 hospital billing forms, and HCFA 1500 forms.
  • Ability to review client/payer contracts to identify complex underpayments.
  • Regular and predictable attendance is required.
  • Equivalent combination of education and experience will be considered.
  • Preferred experience: proven ability to meet or exceed productivity targets and goals.
  • Preferred traits: self-starter, able to work independently, strong written and verbal communication, analytical and problem-solving skills, and ability to manage multiple priorities.

Benefits

  • Remote, full-time work arrangement.
  • Opportunity to work for an award-winning company recognized for growth and workplace culture.
  • Professional growth and development support.
  • Tools, resources, and support to help employees thrive in their careers.
  • Flexible and family-oriented work environment, according to employee testimonials.
  • Commitment to work-life balance and employee support.
  • Equal opportunity employer environment.

Interested in this position?

Apply directly on the company website

Apply Now

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