Resolution Analyst – Denials

Role Overview

• Acts as the liaison between key client contacts and our denials and underpayment appeal process to the appropriate payer.
• Responsible for facilitating payment review recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing the departments revenue.
• Responsible for handling patient health information (PHI) and maintaining extreme privacy and security.

Requirements

• High School Diploma or GED required. Associates or Bachelor’s Degree preferred.
• 5+ years’ experience in healthcare field working in billing or collections.
• 1+ years’ client facing/customer services experience.
• Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements.
• Equivalent combination of education and experience will be considered.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.
• Strong understanding of the revenue cycle process.
• Full understanding of hospital reimbursement, Intermediate knowledge of Managed Care contracts, Contract Language, and Federal and State requirements.
• Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims.
• Intermediate understanding of EOB, hospital billing form requirements (UB04), and familiarity with the HCFA 1500 forms.
• Demonstrate strong ability to review client/payer contracts to identify complex underpayments.
• Regular and predictable attendance.
• Must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Benefits

• EnableComp is an Equal Opportunity Employer M/F/D/V.
• A commitment to creating and maintaining a workforce environment that is free from discrimination or harassment.
• A culture centered around fostering the professional growth and development of employees.
• A commitment to living up to core values each day.