Underpayment Analyst, Denials - Zero Balance (REMOTE)

enablecomp; Franklin (TN); Remote; USD 55,000 - 75,000; Full time

Job summary

EnableComp is seeking a Resolution Analyst in Franklin, TN to act as a liaison between client contacts and our denial and underpayment appeal process. You will facilitate payment review recovery for denied and underpaid accounts for assigned clients, handling PHI with strict privacy and security.

You will review claims, use payer docs and contracts to determine correct reimbursement, and follow up with payers to ensure timely resolution.

Qualifications

• 5+ years' experience in healthcare field working in billing or collections.
• 1+ years' client facing/customer services experience.
• Understanding of ICD, HCPCS/CPT coding, and medical terminology.
• Strong understanding of the revenue cycle process.
• Familiarity with hospital reimbursement and managed care terms.
• Proficiency with MS Office (Word, Excel, Outlook).

Responsibilities

• Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, and other assigned claims.
• Use payer documentation and contract information to determine correct reimbursement.
• Identify cash payments from insurance companies by reviewing hospital contracts.
• Gather medical records and documentation to submit complex underpayments appeals.
• Conduct timely telephone follow-up with payers to resolve receivables.
• Ensure smooth operations and improve customer satisfaction.
• Other duties as required.

Skills

Billing & Collections

Healthcare Revenue Cycle

Customer Service

MS Office Proficiency

Contract & Payer Knowledge

Analytical Skills

Privacy & PHI Handling

Education

Bachelor's or Associate Degree in Healthcare or related

Equivalent combination of education and experience

Tools

Hospital Billing Software

Proprietary EnableComp software

Job description

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 Resolution Analyst is responsible for facilitating payment review recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing the department's 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.

Key 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.
• Ensures smooth operations and improves customer satisfaction.
• Other duties as required.

Requirements and Qualifications

• 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.
• To perform this job successfully, an individual 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.

Special Considerations and Prerequisites

• Practices and adheres to EnableComp's Core Values, Vision and Mission.
• Proven ability to meet and/or exceed productivity targets and goals.
• Maintains stable performance under pressure or opposition. Handles stress in ways to maintain relationships with all stakeholders.
• Must be a self-starter and able to work independently without direct supervision.
• Proven 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.
• Must be able to remain in stationary position 50% of the time.
• Occasionally moves about inside the office to access office equipment, etc.
• Constantly operates a computer and other office equipment such as a copy/scan/print machine, phone and computer.

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.