Revenue Specialist – Denials

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

📋 Description

• Serve as the intermediary between key client representatives and the denials appeal process with the relevant payer.

• Analyze and assess denied and assigned claims utilizing EnableComp’s proprietary software, systems, and tools.

• Leverage payer payment records and medical provider contract details to ascertain accurate reimbursement.

• Perform the initial denial audit and execute actions to remedy outstanding claims.

• Investigate, request, and gather necessary medical records and supporting documentation.

• Submit supporting documents alongside hospital claims to the appropriate payer for prompt and accurate reimbursement.

• Conduct timely and comprehensive telephone follow-ups with payers.

• Confirm that claims documentation is received and facilitate prompt reimbursement.

• Manage patient health information (PHI) while ensuring the strict privacy and security of confidential and proprietary details.

• Carry out additional responsibilities as needed.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• An Associate's or Bachelor’s Degree is preferred.

• Over 5 years of experience in the healthcare sector, specifically in billing or collections.

• Minimum of 1 year of client-facing/customer service experience.

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

• An equivalent blend of education and experience will be taken into account.

• Proficient in computer use and basic office software, including MS Office (Word, Excel, and Outlook).

• Intermediate familiarity with ICD, HCPCS/CPT coding, and medical terminology.

• Strong grasp of the revenue cycle process.

• Comprehensive understanding of hospital reimbursement.

• Intermediate knowledge of Managed Care contracts, contract terminology, and federal and state regulations.

• Acquainted with HMO, PPO, IPA, and capitation concepts and claims processing.

• Intermediate understanding of EOB and hospital billing form requirements (UB04).

• Familiar with HCFA 1500 forms.

• Capable of reviewing client/payer contracts to detect intricate underpayments.

• Consistent and predictable attendance is required.

• Ability to fulfill essential duties satisfactorily, with reasonable accommodations as necessary.

• Capacity to meet or surpass productivity targets and goals.

• Ability to work independently without direct oversight.

• Proven skills in written and verbal communication.

• Strong analytical and problem-solving capabilities.

• Experience in working with external clients, along with strong customer service skills and business awareness.

• Ability to prioritize and manage multiple competing projects and tasks simultaneously.

• Capacity to remain stationary for 50% of the time.

• Ability to continuously operate a computer and office equipment.

🏝️ Benefits

• Full-time employment.

• Opportunities for professional growth and development.

• Access to tools, resources, and support for career advancement.

• A flexible, family-oriented work environment.

• Support for work-life balance.