Resolution Analyst – Denials

Emploi pas sur LinkedIn

🕒 il y a 23 jours

🎸 Tennessee – Distant

🎸 Tennessee – Remote

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

🧐 Analyste

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EnableComp

Site WebLinkedInTous les Emplois

501 - 1000 employés

⚕️ Assurance santé

☁️ SaaS

💸 Finance

💰 Venture Round en 2022-07

Healthcare Insurance • SaaS • Finance

EnableComp est une entreprise spécialisée dans la gestion du cycle de revenus (GCR) pour les prestataires de soins de santé et les systèmes de santé à travers les États-Unis. Elle se concentre sur le traitement des réclamations complexes liées à l'Administration des Anciens Combattants, à l'indemnisation des accidents du travail, aux accidents de la route et à Medicaid hors de l'État, ainsi que sur la gestion des refus pour toutes les classes de payeurs. En s'appuyant sur l'automatisation intelligente et sa plateforme propriétaire E360 RCM™, EnableComp aide les prestataires de soins de santé à augmenter leurs revenus, à contrôler leurs coûts et à rationaliser les processus de facturation. Forte de son expertise dans le traitement des réclamations complexes, l'entreprise garantit un remboursement précis et rapide, offrant une amélioration significative des recouvrements et des performances financières de ses 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.

🎯 Exigences

• 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.

🏖️ Avantages

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