Revenue Specialist, Denials

Summary

Join EnableComp as a Revenue Specialist, Denials and act as a liaison between clients and the denials appeal process. You will be responsible for auditing denied claims, resolving outstanding claims, and ensuring patient health information (PHI) privacy and security. This role requires reviewing and evaluating denied claims, researching and acquiring necessary documentation, and following up with payers to facilitate prompt reimbursement. You will utilize EnableComp’s proprietary software and tools to determine correct reimbursement and work to ensure prompt and correct claims reimbursement. The position involves handling patient health information (PHI) and maintaining extreme privacy and security. EnableComp offers a supportive and collaborative work environment, committed to employee growth and development.

Requirements

• High School Diploma or GED required
• 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

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
• Other duties as required

Preferred Qualifications

• Associates or Bachelor’s Degree preferred
• 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