Resolution Analyst, Denials

Enablecomp; North Carolina; On-site; USD 50,000 - 65,000; Full time

Job summary

EnableComp is seeking a Resolution Analyst to ensure recovery efforts for denied and underpaid accounts, improving departmental revenue and maintaining patient privacy. This role requires strong analytical skills, client-facing experience, and a deep understanding of healthcare billing.

The ideal candidate will have at least 5 years in healthcare billing, with a High School Diploma or GED; a Bachelor's degree is preferred. Experience with MS Office and claims processing is essential for this position.

Qualifications

• 5+ years’ experience in healthcare billing or collections.
• Ability to review client/payer contracts to identify complex underpayments.
• Familiarity with hospital reimbursement and claims processing.

Responsibilities

• Review, evaluate, appeal, and follow up on outstanding claims.
• Use payment documentation to determine correct reimbursement.
• Research and submit complex underpayment appeals to appropriate payers.
• Conduct timely follow-up with payers on claims.
• Ensure smooth operations and improve customer satisfaction.

Skills

Healthcare billing or collections experience

Client-facing/customer service experience

Computer proficiency

Understanding of ICD, HCPCS/CPT coding

Analytical and problem-solving skills

Written and verbal communication skills

Education

High School Diploma or GED

Associate's or Bachelor's Degree preferred

Tools

MS Office (Word, Excel, Outlook)

Job description

Company Overview

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry‑leading expertise and its unified E360 RCM intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human‑in‑the‑loop integration, EnableComp offers solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out‑of‑State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data‑rich performance management.

Position Summary

The Resolution Analyst acts as the liaison between key client contacts and our denials and underpayment appeal process to the appropriate payer. The Analyst facilitates payment review recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing departmental revenue and maintaining extreme privacy and security of patient health information (PHI).

Responsibilities

• Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, and other assigned claims using EnableComp’s proprietary software, systems and tools.
• Use payment documentation provided by payers and medical provider contract information to determine the correct reimbursement.
• Efficiently review hospital contracts to identify and collect cash payments from insurance companies, ensuring prompt payments of denied and underpaid claims.
• 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.
• Conduct timely and thorough telephone follow‑up with payers to ensure claims with supporting documentation have been received and facilitate resolution of outstanding receivables.
• Ensure smooth operations and improve customer satisfaction.
• Perform other duties as required.

Qualifications

• High School Diploma or GED required; Associate’s or Bachelor’s Degree preferred.
• 5+ years’ experience in healthcare billing or collections.
• 1+ year of client‑facing/customer service experience.
• Intermediate understanding of insurance payer/provider claims processing and subsequent data requirements.
• Equivalent combination of education and experience will be considered.
• Strong computer proficiency and ability to use basic office applications, including MS Office (Word, Excel, 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 payers 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.
• Ability to adhere to reasonable accommodations for qualified individuals with disabilities to perform the essential functions.
• Practice and adherence to EnableComp’s Core Values, Vision, and Mission.
• Proven ability to meet and/or exceed productivity targets and goals.
• Maintain stable performance under pressure or opposition; handle stress while maintaining stakeholder relationships.
• Self‑starter capable of working independently without direct supervision.
• Strong written and verbal communication skills.
• Strong analytical and problem‑solving skills.
• Proven experience working with external clients; strong customer service skills and business acumen.
• Ability to prioritize and manage multiple competing priorities and projects concurrently.
• Remain in a stationary position 50% of the time; occasionally move about inside the office to access equipment.
• Constantly operate a computer and other office equipment such as a copy/scan/print machine, phone, and computer.

Equal Employment Opportunity

EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.