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Underpayment Analyst, Denials - Zero Balance (REMOTE)

1 month, 3 weeks ago
United States
Full-time
Senior
Operations Specialist
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 16

Description

  • Review, evaluate, appeal, and follow up on denied, underpaid, and other assigned claims using proprietary systems and tools.
  • Use payer payment documentation and provider contract information to determine correct reimbursement amounts.
  • Review hospital contracts to identify and recover cash payments from insurance companies.
  • Research, request, and obtain medical records and supporting documentation for complex underpayment appeals.
  • Prepare and submit accurate and timely appeals to the appropriate payer.
  • Conduct timely telephone follow-up with payers to confirm receipt of documentation and advance claim resolution.
  • Support smooth operations and contribute to customer satisfaction.
  • Handle protected health information (PHI) with strict attention to privacy and security.

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 payers process claims.
  • Intermediate understanding of EOBs, UB04 billing form requirements, and familiarity with HCFA 1500 forms.

Benefits

  • Equal Opportunity Employer with a commitment to a discrimination- and harassment-free workplace.
  • Professional growth and development support through a culture focused on investing in employees.
  • Tools, resources, and support to help employees thrive and grow their careers.
  • Flexible, family-oriented work culture that supports work-life balance.
  • Supportive environment that emphasizes cooperation, shared goals, and employee wellbeing.

Interested in this position?

Apply directly on the company website

Apply Now

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