Resolution Analyst, Denials

📋 Description

• Review, appeal, and follow up on denied/underpaid claims with EnableComp tools.
• Use payer docs and contracts to determine correct reimbursement.
• Review hospital contracts to collect payments and reduce denials.
• Research and obtain medical records for complex underpayment appeals.
• Follow up with payers by phone to confirm receipt and resolve receivables.
• Ensure smooth operations and improve customer satisfaction.
• Perform other duties as required.

🎯 Requirements

• High School Diploma or GED required; Associates/Bachelor’s preferred.
• 5+ years in healthcare billing or collections.
• 1+ years client-facing/customer service experience.
• Intermediate understanding of payer processing and data requirements.
• MS Office (Word, Excel, Outlook) proficiency.
• ICD, HCPCS/CPT coding and medical terminology.
• Strong understanding of the revenue cycle.
• Familiarity with EOB, UB04, and HCFA 1500 forms.