Underpayment Analyst, Denials – Zero Balance

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

📋 Description

• Assess, evaluate, appeal, and track outstanding, denied, underpaid, 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 correct reimbursement amounts.

• Effectively analyze hospital contracts to identify and gather cash payments from insurance companies, ensuring timely resolution of denied and underpaid claims.

• Investigate, request, and obtain all relevant medical records and supporting documentation to formulate and submit complex underpayment appeals to the appropriate payer, guaranteeing precise and prompt claim reimbursement.

• Conduct prompt and thorough follow-up calls with payers to confirm receipt of claims with supporting documentation and to expedite the resolution of outstanding receivables.

• Ensure efficient operations and enhance customer satisfaction.

• Perform additional duties as necessary.

⛳️ Requirements

• High School Diploma or GED is mandatory; an Associate’s or Bachelor’s Degree is preferred.

• Minimum of 5 years of experience in the healthcare field, specifically in billing or collections.

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

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

• Equivalent combinations of education and experience will be taken into consideration.

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

• Intermediate knowledge of ICD, HCPCS/CPT coding, and medical terminology is required.

• Solid understanding of the revenue cycle process.

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

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

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

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

• Regular and predictable attendance is required.

• To succeed in this role, an individual must be able to satisfactorily perform each essential duty. Reasonable accommodations may be made to enable qualified individuals with disabilities to fulfill the essential functions.

🏝️ Benefits

• Competitive salary

• Health insurance

• Flexible working hours

• Opportunities for professional development

• Bonuses