Revenue Specialist, Denials

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

📋 Description

• Assess and analyze Denied and other assigned claims utilizing EnableComp’s proprietary software, systems, and tools.

• Utilize payment documentation from payers and medical provider contract details to ascertain the appropriate reimbursement amount.

• Investigate, request, and gather all necessary medical records and supporting documentation, then submit them alongside hospital claims to the relevant payer to ensure timely and accurate claims reimbursement.

• Perform prompt and comprehensive telephone follow-ups with payers to confirm the receipt of claims along with supporting documentation and to facilitate swift reimbursement.

• 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.

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

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

• A combination of education and experience may be considered.

• Must possess strong computer skills and be proficient in basic office applications, including MS Office (Word, Excel, and Outlook).

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

• Solid grasp of the revenue cycle process.

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

• Familiarity with HMO, PPO, IPA, and capitation terms, including how these payors process claims.

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

• Proven ability to review client/payer contracts to identify complex underpayments.

• Consistent and reliable attendance.

🏝️ Benefits

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

• Dedicated to fostering a workplace environment that is free from any form of discrimination or harassment.

• A culture focused on promoting the professional growth and development of our employees.

• Ongoing commitment to investing in the success of our team members.