Enablecomp

Underpayment Analyst, Denials - Zero Balance (REMOTE)

Franklin, TN

Sponsorship not specifiedDetected 11 days ago

AlgorithmsExcelCustomer SupportAR/VRHIPAAICD-10ResearchCommunicationProblem SolvingMicrosoft OfficeClaims Management

About the role

The Resolution Analyst acts as the liaison between key client contacts and our denials and underpayment appeal process to the appropriate payer.
The Resolution Analyst is responsible for facilitating payment review recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing the departments revenue.
This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.

Maintains stable performance under pressure or opposition. Handles stress in ways to maintain relationships with all stakeholders.

1+ years' client facing/customer services experience.
Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
Strong understanding of the revenue cycle process.
Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims.
Demonstrate strong ability to review client/payer contracts to identify complex underpayments.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
Other duties as required.
Must be a self-starter and able to work independently without direct supervision.

Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers' Compensation, M

Use payment documentation provided by payers and medical provider contract information to determine the correct reimbursement.
Research, request, and acquire all pertinent medical records and supporting documentation to create and submit complex underpayment appeals to the appropriate payer, ensuring accurate and timely claim reimbursement.
5+ years' experience in healthcare field working in billing or collections.
Equivalent combination of education and experience will be considered.
Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.
Full understanding of hospital reimbursement, Intermediate knowledge of Managed Care contracts, Contract Language, and Federal and State requirements.
Practices and adheres to EnableComp's Core Values, Vision and Mission.

This listing is sourced directly from Enablecomp's careers page and normalized into a canonical job model.