[Remote] Revenue Specialist, Denials at EnableComp

United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

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
Strong computer proficiency and understanding of basic office applications
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
Demonstrated ability to review client/payer contracts to identify complex underpayments
Regular and predictable attendance

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
Identify complex underpayments and develop strategies to resolve them
Maintain extreme privacy and security as it relates to confidential and proprietary information
Perform tasks as required by the position

Skills

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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