Resolution Analyst, Denials

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. EnableComp supports revenue cycle solutions across 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 optimize the reimbursement process, EnableComp aims to accelerate cash flow, improve yield, manage clean AR, reduce denials, and provide data-rich performance management. 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 status, disability or veteran status. We are committed to maintaining a workforce environment free from discrimination or harassment. Position Summary The Resolution Analyst acts as the liaison between key client contacts and the denials and underpayment appeal process to the appropriate payer. The Resolution Analyst is responsible for facilitating payment review and recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing the department’s revenue. This position handles patient health information (PHI) and maintains privacy and security for confidential and proprietary information. Key Responsibilities Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, and other assigned claims using EnableComp’s software, systems, and tools. Use payment documentation provided by payers and medical provider contract information to determine the correct reimbursement. Review hospital contracts to identify and collect cash payments from insurance companies and ensure 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 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. Other duties as required. Requirements and Qualifications High School Diploma or GED required. Associates or Bachelor’s Degree preferred. 5+ years’ experience in healthcare billing or collections. 1+ years’ client-facing/customer services experience. Intermediate understanding of insurance payer/provider claims processing and data requirements. Equivalent combination of education and experience will be considered. Strong computer proficiency with MS Office (Word, Excel, Outlook). Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology. Strong understanding of the revenue cycle process. Knowledge of hospital reimbursement and intermediate knowledge of Managed Care contracts, contract language, and Federal/State requirements. Familiarity with HMO, PPO, IPA, and capitation terms and payor claim processing. Intermediate understanding of EOB, UB04 forms, and HCFA 1500 forms. Ability to review client/payer contracts to identify complex underpayments. Regular and predictable attendance. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential duties. Special Considerations Practices and adheres to EnableComp’s core values, vision, and mission. Proven ability to meet productivity targets and goals. Maintains stable performance under pressure; handles stress to maintain relationships with stakeholders. Self-starter able to work independently without direct supervision. Strong written and verbal communication skills. Strong analytical and problem-solving skills; experience working with external clients and customer service acumen. Ability to prioritize and manage multiple competing priorities and projects concurrently. Must be able to remain in stationary position 50% of the time; occasional office mobility as needed. #J-18808-Ljbffr Medium