Resolution Analyst, Denials

1 week ago
Full-time
Senior
Operations
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
201-500
Founded 2000

Description

  • Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, and assigned claims using company systems and tools.
  • Analyze payer payment documentation and provider contract information to determine correct reimbursement.
  • Review hospital and managed care contracts to identify complex underpayments and recover insurance payments.
  • Research, obtain, and organize medical records and supporting documentation for complex underpayment appeals.
  • Prepare and submit appeals to appropriate payers to support accurate, timely reimbursement.
  • Conduct telephone follow-up with payers to confirm receipt of documentation and resolve outstanding receivables.
  • Protect patient health information and confidential proprietary information.
  • Support smooth operations and customer satisfaction while meeting recovery objectives.

Requirements

  • High school diploma or GED required; associate's or bachelor's degree preferred.
  • 5+ years of healthcare billing or collections experience.
  • 1+ years of client-facing or customer service experience.
  • Intermediate understanding of payer/provider claims processing, data requirements, and the healthcare revenue cycle.
  • Knowledge of hospital reimbursement, managed care contracts, contract language, and federal and state requirements.
  • Intermediate knowledge of ICD and HCPCS/CPT coding, medical terminology, EOBs, UB-04 forms, and HCFA 1500 forms.
  • Familiarity with HMO, PPO, IPA, capitation, and payer claims-processing practices.
  • Ability to review client and payer contracts to identify complex underpayments.
  • Proficiency with MS Office, including Word, Excel, and Outlook.
  • Strong analytical, problem-solving, written communication, customer service, prioritization, and independent-work skills.

Benefits

  • Professional growth and career development support.
  • Access to tools, resources, and support to help employees succeed.
  • Flexible, family-oriented culture that supports work-life balance.

Interested in this position?

Apply directly on the company website

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