Revenue Specialist – Denials

🔥 13 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Act as liaison between key client contacts and the denials appeal process with the appropriate payer • Review and evaluate denied and assigned claims using EnableComp’s proprietary software, systems, and tools • Use payer payment documentation and medical provider contract information to determine correct reimbursement • Conduct the initial denial audit and activities to resolve outstanding claims • Research, request, and acquire pertinent medical records and supporting documentation • Submit supporting documentation with hospital claims to the appropriate payer for prompt, correct reimbursement • Conduct timely and thorough telephone follow-up with payers • Ensure claims documentation has been received and facilitate prompt reimbursement • Handle patient health information (PHI) while maintaining strict privacy and security of confidential and proprietary information • Perform 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 understanding of insurance payer/provider claims processing and data requirements • Equivalent combination of education and experience will be considered • Strong computer proficiency and 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 claims processing • Intermediate understanding of EOB and hospital billing form requirements (UB04) • Familiarity with HCFA 1500 forms • Ability to review client/payer contracts to identify complex underpayments • Regular and predictable attendance • Ability to meet essential duties satisfactorily, with reasonable accommodations as applicable • Ability to meet or exceed productivity targets and goals • Ability to work independently without direct supervision • Proven written and verbal communication skills • Strong analytical and problem-solving skills • Experience working with external clients, strong customer service skills, and business acumen • Ability to prioritize and manage multiple competing priorities and projects concurrently • Ability to remain in a stationary position 50% of the time • Ability to operate a computer and office equipment continuously

🏖️ Benefits

• Full-time employment • Professional growth and development opportunities • Tools, resources, and support for career growth • Flexible, family-oriented work environment • Work-life balance support