Resolution Analyst, Denials

United States

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Not SpecifiedCompensation

Junior (1 to 2 years), Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Revenue Cycle Management, Financial ServicesIndustries

Requirements

Candidates must possess a High School Diploma or GED, with an Associate's or Bachelor's degree preferred. A minimum of 5 years of experience in healthcare billing or collections is required, along with over 1 year of client-facing customer service experience. Intermediate understanding of insurance payer/provider claims processing, ICD, HCPCS/CPT coding, medical terminology, revenue cycle processes, Managed Care contracts, and various payer types (HMO, PPO, IPA, capitation) is necessary. Strong computer proficiency with MS Office (Word, Excel, Outlook) and the ability to review client/payer contracts for complex underpayments are essential. Familiarity with EOBs, UB04, and HCFA 1500 forms is also required.

Responsibilities

The Resolution Analyst will review, evaluate, appeal, and follow up on denied and underpaid claims using proprietary software. They will determine correct reimbursement based on payer documentation and provider contracts, and efficiently collect cash payments from insurance companies. This role involves researching and acquiring medical records for complex underpayment appeals and conducting telephone follow-ups with payers to facilitate claim resolution. The analyst will also ensure smooth operations, improve customer satisfaction, and maintain strict privacy and security for patient health information.

Skills

Denial Management

Underpayment Recovery

Claims Appeals

Payer Follow-up

Revenue Cycle Management

Healthcare Claims

Patient Health Information (PHI)

Privacy and Security

Communication

Problem-Solving

EnableComp

Maximizes revenue from workers' compensation claims

About EnableComp

EnableComp focuses on helping healthcare providers maximize revenue from complex workers' compensation claims, which are often difficult to manage. The company simplifies this process by using a combination of clinical expertise, data analytics, managed care, and proprietary technology. Their main product, Enforcer, is a software that streamlines the management of these claims, allowing healthcare providers to concentrate on their core operations while EnableComp handles the billing and collections. Unlike competitors, EnableComp operates on an outsourcing model, taking over the claims management process for healthcare providers, which saves them time and resources. The goal of EnableComp is to ensure that their clients receive the highest possible reimbursement from workers' compensation claims.

Franklin, TexasHeadquarters

2000Year Founded

$5.3MTotal Funding

MERGERCompany Stage

Data & Analytics, Consulting, HealthcareIndustries

201-500Employees

Benefits

Flexible Work Hours

Professional Development Budget

Unlimited Paid Time Off

Risks

Emerging RCM technology companies may erode EnableComp's market share with competitive solutions.

Labor shortages in healthcare could impact EnableComp's service delivery and client satisfaction.

Frank Forte's appointment as CEO may lead to strategic shifts, risking client retention.

Differentiation

EnableComp specializes in complex workers' compensation claims management for healthcare providers.

Their proprietary software, Enforcer, enhances efficiency in claims processing and collections.

EnableComp's outsourcing model allows healthcare providers to focus on core operations.

Upsides

Increased AI adoption enhances EnableComp's claims processing and denial management efficiency.

RPA integration in billing offers automation opportunities, improving accuracy for EnableComp.

Healthcare providers' outsourcing trend aligns with EnableComp's business model, boosting partnerships.

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