Denials Resolution Analyst - Underpayments

October 12

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EnableComp

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Workers'​ Compensation Collections • Complex Claims • Motor Vehicle Accident Claims • Veterans Administration Claims • Revenue Cycle Management

501 - 1000

💰 Venture Round on 2022-07

Description

• Recognized as a 2024 Top Workplace by the Tennessean, EnableComp is the leading source of revenue cycle management solutions for complex claims in the US. • We proudly partner with well over 1000+ hospitals across the US to help them maximize their revenue from complex claims. • Our Mission: We partner with healthcare providers to maximize reimbursement from complex claims payers by having the best people, processes, products and performance. • Our Vision: We enable healthcare providers to do what they do best. • The Denials Resolution Analyst acts as the liaison between key client contacts and our denials and underpayment appeal process to the appropriate payer. • The Revenue Specialist, Denials is responsible for facilitating payment review recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing the departments revenue. • This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.

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.