Resolution Analyst – Denials

Job not on LinkedIn

🕒 5 days ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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EnableComp

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

☁️ SaaS

💸 Finance

💰 Venture Round on 2022-07

Healthcare Insurance • SaaS • Finance

EnableComp is a company that specializes in revenue cycle management (RCM) for healthcare providers and health systems across the United States. They focus on processing complex claims related to Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid, as well as denial management for all payer classes. By leveraging intelligent automation and their proprietary E360 RCM™ platform, EnableComp helps healthcare providers increase revenue, control costs, and streamline billing processes. With expertise in handling complex claims, the company ensures accurate and timely reimbursement, providing significant uplift to collections and improving the financial performance of its clients.

📋 Description

• Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, 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. • Efficiently review hospital contracts to identify and collect cash payments from insurance companies, ensuring prompt payments of denied and underpaid claims. • Research, request, and acquire all pertinent medical records and supporting documentation to create and submit complex underpayment appeals to the appropriate payer, ensuring accurate and timely claim reimbursement. • Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate resolution of outstanding receivables. • Ensures smooth operations and improves customer satisfaction. • Other duties as required.

🎯 Requirements

• 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. • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work arrangements • Professional development opportunities