Zero Balance Auditor

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

📋 Description

• Serves as the intermediary between primary client representatives and our denial and underpayment appeal procedures directed toward the relevant payer.

• Tasked with driving payment review recovery initiatives for denied and underpaid accounts for designated clients, thus enhancing the department's revenue.

• Responsible for managing patient health information (PHI) while upholding the highest standards of privacy and security concerning confidential and proprietary data.

• Review, assess, appeal, and pursue outstanding, denied, underpaid, and other designated claims.

• Leverage payment documentation provided by payers along with medical provider contract information to ascertain the correct reimbursement amount.

• Effectively analyze hospital contracts to pinpoint and recover cash payments from insurance companies.

• Investigate, request, and gather all relevant medical records and supporting documents to prepare and submit complex underpayment appeals.

• Conduct prompt and comprehensive telephone follow-ups with payers to confirm receipt of claims along with supporting documentation.

• Ensures seamless operations and enhances customer satisfaction.

⛳️ 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 experience in client-facing or customer service roles.

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

• An equivalent combination of education and experience may be considered.

• Proficient in computer skills with a solid grasp of basic office applications, including MS Office (Word, Excel, and Outlook).

• Intermediate knowledge 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 and their impact on claims processing.

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

• Strong capability to scrutinize client/payer contracts to identify complex underpayment situations.

• Consistent and predictable attendance.

🏝️ Benefits

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

• Ongoing commitment to creating and sustaining a culture dedicated to fostering the professional growth and development of employees.

• Commitment to equipping employees with the necessary tools, resources, and support to flourish and advance in their careers.

• A family-oriented and adaptable company culture.

• Team-oriented spirit of cooperation and shared goals.