Resolution Analyst, Denials

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Serves as the key point of contact between essential client representatives and the appeals process for denials and underpayments.

• Tasked with overseeing recovery efforts for payments related to denied and underpaid accounts.

• Manages patient health information (PHI) while ensuring privacy and security are upheld.

• Reviews, assesses, appeals, and monitors outstanding claims utilizing proprietary software.

• Analyzes payment documentation to establish accurate reimbursement amounts.

• Evaluates hospital contracts to pinpoint and collect cash payments from insurance providers.

• Investigates, requests, and gathers medical records to formulate and submit intricate underpayment appeals.

• Makes follow-up calls to payers to confirm that claims accompanied by supporting documentation have been received.

⛳️ Requirements

• A High School Diploma or GED is required; an Associate's or Bachelor's Degree is preferred.

• A minimum of 5 years’ experience in the healthcare sector, specifically in billing or collections.

• At least 1 year of experience in a client-facing or customer service role.

• Intermediate knowledge of insurance payer/provider claims processing and data requirements.

• Proficient computer skills and familiarity with basic office applications (MS Office).

• Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.

• Strong comprehension of the revenue cycle process.

• Comprehensive understanding of hospital reimbursement, along with intermediate knowledge of Managed Care contracts, contract language, and federal and state regulations.

• Familiarity with HMO, PPO, IPA, and capitation terms as well as claims processing.

• Intermediate knowledge of EOB, hospital billing form requirements (UB04), and HCFA 1500 forms.

• Strong capability to review client/payer contracts to identify complex underpayments.

• Consistent and dependable attendance is expected.

🏝️ Benefits

• EnableComp is an Equal Opportunity Employer M/F/D/V.

• All applicants will be evaluated based on their experience and qualifications.

• Ongoing commitment to professional growth and development.

• Family-friendly and flexible work environment.