Resolution Analyst, Denials

🕒 July 7

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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EnableComp

WebsiteLinkedInAll Job Openings

501 - 1000 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Venture Round on 2022-07

Consulting • Insurance • Logistics

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

• Acts as the liaison between key client contacts and the denials and underpayment appeal process. • Responsible for facilitating payment review recovery efforts for denied and underpaid accounts. • Handles patient health information (PHI) while maintaining privacy and security. • Reviews, evaluates, appeals, and follows up on outstanding claims using proprietary software. • Uses payment documentation to determine correct reimbursement. • Reviews hospital contracts to identify and collect cash payments from insurance companies. • Researches, requests, and acquires medical records to create and submit complex underpayment appeals. • Conducts phone follow-ups with payers to ensure claims with supporting documentation have been received.

🎯 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 data requirements. • Strong computer proficiency and understanding of basic office applications (MS Office). • 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 claims processing. • Intermediate understanding of EOB, hospital billing form requirements (UB04), and HCFA 1500 forms. • Strong ability to review client/payer contracts to identify complex underpayments. • Regular and predictable attendance.

🏖️ Benefits

• EnableComp is an Equal Opportunity Employer M/F/D/V. • All applicants will be considered based on experience and knowledge. • Continuous commitment to professional growth and development. • Family-oriented and flexible work environment.