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Zero Balance Auditor

3 weeks, 2 days ago
United States
Full-time
Senior
Accountant
Operations
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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 11

Description

  • Review, evaluate, appeal, and follow up on denied, underpaid, and other assigned claims using EnableComp’s proprietary software and tools.
  • Use payer payment documentation and provider contract information to determine correct reimbursement amounts.
  • Review hospital contracts to identify underpayments and collect cash payments from insurance companies.
  • Research, request, and obtain medical records and supporting documentation for complex underpayment appeals.
  • Prepare and submit appeals to the appropriate payer in a timely and accurate manner.
  • Conduct telephone follow-up with payers to confirm receipt of supporting documentation and resolve outstanding receivables.
  • Maintain privacy and security of patient health information and confidential proprietary information.
  • Support smooth operations and contribute to 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, preferably 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 Microsoft Office Word, Excel, and Outlook.
  • Intermediate knowledge 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 forms, and HCFA 1500 forms.
  • Strong ability to review client and payer contracts to identify complex underpayments.
  • Regular and predictable attendance is required.
  • Equivalent combination of education and experience will be considered.
  • Must be able to perform essential duties satisfactorily, with reasonable accommodations available for qualified individuals with disabilities.
  • Experience meeting or exceeding productivity targets and goals is preferred.
  • Strong written and verbal communication, analytical, problem-solving, and customer service skills are required.
  • Must be a self-starter who can work independently and manage multiple competing priorities.
  • Experience working with external clients and business acumen are preferred.

Benefits

  • Professional growth and development support with tools, resources, and ongoing investment in employees.
  • Flexible, family-oriented work culture that values work-life balance.
  • Opportunity to work for a multi-year Top Workplaces award recipient and a fast-growing industry leader.
  • Equal opportunity employer committed to a discrimination-free workplace.

Interested in this position?

Apply directly on the company website

Apply Now

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