Revenue Specialist, Denials

Position Summary

The Revenue Specialist, Denials acts as the liaison between key client contacts and our denials appeal process to the appropriate payer. The Revenue Specialist, Denials is responsible for the initial denial audit and activities to resolve outstanding claims. 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 and evaluate Denied 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.
• Research, request and acquire all pertinent medical records and any other supporting documentation necessary and then submit with hospital claims to the appropriate payer to ensure prompt correct claims reimbursement.
• Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate prompt reimbursement.
• 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.