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Posted 8 days ago

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Resolution Analyst, Denials

Franklin, TNOn-siteFull-time

AI Summary

The Resolution Analyst acts as the liaison between client contacts and the denials/underpayment appeal process, reviewing and pursuing payment recovery for denied and underpaid claims to improve client reimbursement.

About this role

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 provides 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. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.

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 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.

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.

    • Skills

    Claims ProcessingContract InterpretationContract LanguageData RequirementsDenials ManagementEOB UnderstandingHCFA 1500 FormsHCPCS/CPT CodingICD CodingMedical TerminologyMS Office (Word, Excel, Outlook)Payer NegotiationsRevenue CycleUB04 FormsUnderpayment Appeals

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