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Revenue Specialist, Denials

2 hours, 6 minutes ago
United States
Full-time
Senior
Accountant
Operations
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 9

Description

  • Review and evaluate denied and other assigned claims using EnableComp’s proprietary software, systems, and tools.
  • Use payer payment documentation and provider contract information to determine the correct reimbursement.
  • Research, request, and collect medical records and supporting documentation needed for claim resolution.
  • Submit claims and supporting documentation to the appropriate payer to support prompt and correct reimbursement.
  • Conduct timely telephone follow-up with payers to confirm receipt of documentation and advance payment resolution.
  • Act as a liaison between key client contacts and the denial appeal process.
  • Perform initial denial audits and work to resolve outstanding claims.
  • Maintain privacy and security for patient health information (PHI) and other confidential information.
  • Complete 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+ year 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 payers 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.
  • Equivalent combination of education and experience will be considered.
  • Regular and predictable attendance is required.
  • Must be able to work independently without direct supervision.
  • Strong written and verbal communication, analytical, and problem-solving skills.
  • Ability to prioritize and manage multiple competing priorities and projects concurrently.

Benefits

  • Remote full-time work arrangement.
  • Opportunity to join an award-winning, fast-growing company.
  • Career growth and professional development support.
  • Work environment that emphasizes flexibility and work-life balance.
  • Culture centered on core values, teamwork, and shared goals.

Interested in this position?

Apply directly on the company website

Apply Now

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