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Zero Balance Auditor
EnableCompResolution Analyst responsible for facilitating payment review recovery for denied and underpaid accounts. Engage with clients to enhance revenue cycles and manage patient health information securely.
About the role
Key responsibilities & impact- Acts as the liaison between key client contacts and our denials and underpayment appeal process to the appropriate payer.
- Responsible for facilitating payment review recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing the department's revenue.
- Responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.
- Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, and other assigned claims.
- 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.
- Research, request, and acquire all pertinent medical records and supporting documentation to create and submit complex underpayment appeals.
- Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received.
- Ensures smooth operations and improves customer satisfaction.
Requirements
What you’ll need- 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.
- Strong computer proficiency and understanding of 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.
- Strong ability to review client/payer contracts to identify complex underpayments.
- Regular and predictable attendance.
Benefits
Comp & perks- EnableComp is an Equal Opportunity Employer M/F/D/V.
- Continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of employees.
- Dedication to providing employees with the tools, resources, and support they need to thrive and grow their career.
- A family-oriented and flexible company culture.
- Team spirit of cooperation and shared goals.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Claims ReviewPayment RecoveryContract EvaluationMedical TerminologyEOB UnderstandingHospital Billing FormsData AnalysisUnderpayment AppealsInsurance Payer KnowledgeRevenue Cycle Process
Soft Skills
CommunicationCustomer Satisfaction FocusAttention to DetailProblem SolvingOrganizational Skills