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EnableComp · 1 day ago

Resolution Analyst, Denials

United States

Full-time

Remote

Senior Level

5+ years exp

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, and they are seeking a Resolution Analyst to act as a liaison between key client contacts and the denials and underpayment appeal process. The role involves facilitating payment review recovery efforts for denied and underpaid accounts, thereby increasing departmental revenue while handling patient health information with confidentiality.

Health CareHospitalInformation Technology

Responsibilities

Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, and other assigned claims using EnableComp’s proprietary software, systems and tools

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, ensuring prompt payments of denied and underpaid claims

Research, request, and acquire all pertinent medical records and supporting documentation to create and submit complex underpayment appeals to the appropriate payer, ensuring accurate and timely claim reimbursement

Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate resolution of outstanding receivables

Ensures smooth operations and improves customer satisfaction

Other duties as required

Qualification

Healthcare billing experienceClaims processing knowledgeICDHCPCS/CPT codingRevenue cycle understandingMS Office proficiencyCustomer service experienceAnalytical skillsCommunication skillsProblem-solving skillsSelf-starter

Required

High School Diploma or GED required

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

Practices and adheres to EnableComp's Core Values, Vision and Mission

Proven ability to meet and/or exceed productivity targets and goals

Maintains stable performance under pressure or opposition. Handles stress in ways to maintain relationships with all stakeholders

Must be a self-starter and able to work independently without direct supervision

Proven written and verbal communication skills

Strong analytical and problem-solving skills

Proven experience working with external clients; strong customer service skills and business acumen

Ability to prioritize and manage multiple competing priorities and projects concurrently

Must be able to remain in stationary position 50% of the time

Occasionally moves about inside the office to access office equipment, etc

Constantly operates a computer and other office equipment such as a copy/scan/print machine, phone and computer