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Resolution Analyst, Denials

50 minutes ago
United States
Full-time
Senior
Customer Support
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 systems and tools.
  • Use payer payment documentation and provider contract information to determine the correct reimbursement amount.
  • Review hospital contracts to identify and collect cash payments from insurance companies for denied and underpaid claims.
  • Research, request, and obtain medical records and supporting documentation for complex underpayment appeals.
  • Prepare and submit accurate and timely appeal packages to the appropriate payer.
  • Conduct timely telephone follow-up with payers to confirm receipt of documentation and resolve outstanding receivables.
  • Support smooth operations and contribute to customer satisfaction.
  • Handle patient health information (PHI) while maintaining strict privacy and security standards.
  • Perform other duties as required.

Requirements

  • High School Diploma or GED is required; an Associate’s or Bachelor’s degree is preferred.
  • 5+ years of experience in the healthcare field working in billing or collections.
  • 1+ year of client-facing or customer service experience.
  • Intermediate understanding of insurance payer and provider claims processing and related data requirements.
  • Strong computer proficiency, including basic office applications such as Microsoft 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 payers process claims.
  • Intermediate understanding of EOBs, UB-04 hospital billing forms, and HCFA 1500 forms.
  • Ability to review client and payer contracts to identify complex underpayments.
  • Proven ability to meet or exceed productivity targets and goals.
  • Must be able to work independently, prioritize multiple competing projects, and maintain stable performance under pressure.
  • Strong written and verbal communication, analytical, and problem-solving skills.
  • Experience working with external clients and strong customer service/business acumen.
  • Regular and predictable attendance is required.
  • Ability to remain stationary for 50% of the time and use a computer and office equipment consistently.

Benefits

  • Remote, full-time position.
  • Opportunity to join a multi-year Top Workplaces employer.
  • Work for a company recognized as Black Book’s #1 Specialty Revenue Cycle Management Solution provider in 2024.
  • Join an employer dedicated to professional growth and development.
  • Work in a flexible, family-oriented culture that supports work-life balance.
  • Opportunity to use tools, resources, and support designed to help employees thrive and grow their careers.

Interested in this position?

Apply directly on the company website

Apply Now

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