Resolution Analyst – Denials
EnableComp
full-time
Posted on:
Location Type: Remote
Location: Tennessee • United States
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About the role
- Act as the liaison between key client contacts and our denials and underpayment appeal process.
- Facilitate payment review recovery efforts for denied and underpaid accounts.
- Handling patient health information (PHI) with extreme privacy and security.
- Review, evaluate, appeal, and follow up on outstanding claims using proprietary software.
- Use payment documentation provided by payers to determine correct reimbursement.
- Collaborate with clients to supercharge the reimbursement process.
- Conduct timely and thorough follow-up with payers to ensure claims resolution.
- Ensures smooth operations and improves customer satisfaction.
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.
- 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.
- Familiarity with HMO, PPO, IPA, and capitation terms.
- Intermediate understanding of EOB, hospital billing form requirements (UB04), and familiarity with the 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.
- Committed to creating a workforce environment free from discrimination.
- Continuous commitment to employee professional growth.
- Family oriented and flexible work arrangements.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims processingICD codingHCPCS codingCPT codingmedical terminologyhospital reimbursementManaged Care contractsEOBhospital billing form requirementsHCFA 1500 forms
Soft skills
customer servicecommunicationcollaborationproblem-solvingattention to detailorganizational skillsfollow-upclient relationstime managementadaptability
Certifications
High School DiplomaGEDAssociates DegreeBachelor’s Degree