Coding and Billing Auditor

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

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.

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.
• 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.
• 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.
• Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Maintains stable performance under pressure or opposition. Must be a self-starter and able to work independently without direct supervision.

strong customer service skills and business acumen.

Ability to prioritize and manage multiple competing priorities and projects concurrently.

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.

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. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you.

There is a genuine spirit of cooperation and shared goals all revolving around helping each other." This company is family oriented and flexible, along with understanding the balance of work, life, and fun." Supervisor, Operations