Revenue Specialist, Denials

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🕒 Julho 22

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EnableComp

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

💼 Consultoria

🛡️ Seguros

📦 Logística

💰 Venture Round em 2022-07

Consulting • Insurance • Logistics

A EnableComp é uma empresa especializada em gerenciamento de ciclo de receita (RCM) para prestadores de saúde e sistemas de saúde em todo os Estados Unidos. Eles se concentram no processamento de sinistros complexos relacionados à Administração de Veteranos, Compensação de Trabalhadores, Acidentes de Veículos Motorizados e Medicaid fora do estado, bem como na gestão de recusas para todas as classes de pagadores. Ao alavancar a automação inteligente e sua plataforma proprietária E360 RCM™, a EnableComp ajuda os prestadores de serviços de saúde a aumentar a receita, controlar custos e simplificar os processos de faturamento. Com expertise no tratamento de sinistros complexos, a empresa garante reembolsos precisos e oportunos, proporcionando um aumento significativo nas cobranças e melhorando o desempenho financeiro de seus clientes.

Descrição

• Review and evaluate Denied and other assigned claims using EnableComp’s proprietary software, systems and tools • Use payment documentation provided by payers and medical provider contract information to determine the correct reimbursement • Research, request and acquire all pertinent medical records and any other supporting documentation necessary and then submit with hospital claims to the appropriate payer to ensure prompt correct claims reimbursement • Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate prompt reimbursement • Other duties as required

🎯 Requisitos

• High School Diploma or GED required • Associates or Bachelor’s Degree preferred • 5+ years’ experience in healthcare field working in billing or collections • 1+ years’ client facing/customer services experience • Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements • Equivalent combination of education and experience will be considered • Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook) • Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology • Strong understanding of the revenue cycle process • Full understanding of 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 payors process claims • Intermediate understanding of EOB, hospital billing form requirements (UB04), and familiarity with the HCFA 1500 forms • Demonstrate strong ability to review client/payer contracts to identify complex underpayments • Regular and predictable attendance

🏖️ Benefícios

• EnableComp is an Equal Opportunity Employer M/F/D/V • Committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment • Culture centered around fostering the professional growth and development of our people • Continuous commitment to investing in our employees’ success