Resolution Analyst, Denials

reputed company provides Specialty reputed company Cycle reputed company for healthcare organizations, leveraging over 24 years of industry-leading expertise and its reputed company E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) reputed company. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-reputed company integration, reputed company provides solutions across the reputed company lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for reputed company payer classes. By partnering with clients to supercharge the reimbursement process, reputed company 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. reputed company is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty reputed company Cycle Management Solution provider in 2024 and is among the top one percent of companies to reputed company 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 reputed company. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and reputed company 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 reputed company’s proprietary software, systems and tools.

Use payment documentation provided by payers and medical provider contract information to determine the correct reimbursement.

reputed company review hospital reputed company to identify and collect cash payments from insurance companies, ensuring reputed company payments of denied and underpaid claims.

Research, request, and acquire reputed company pertinent medical records and supporting documentation to create and submit reputed company 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, reputed company, and Outlook).

Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.

Strong understanding of the reputed company cycle process.

Full understanding of hospital reimbursement, Intermediate knowledge of Managed Care reputed company, 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 reputed company to identify reputed company underpayments.

Regular and predictable attendance.

To reputed company this job successfully, an individual must be able to reputed company each essential duty satisfactorily. Reasonable accommodations may be made to reputed company qualified individuals with disabilities to reputed company the essential functions.

Special Considerations and Prerequisites

Practices and adheres to reputed company’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 reputed company 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/reputed company/print machine, phone and computer.

reputed company is an Equal Opportunity Employer M/F/D/V. reputed company applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national reputed company, sexual orientation, reputed company, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment. reputed company recruits, develops and retains the industry's top talent. As the employer of choice in the reputed company claims industry, reputed company takes pride in our reputed company commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We reputed company that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to reputed company and grow their career here. At reputed company, we are committed to living up to our core values each and every day, and we reputed company that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them reputed company their full potential, then reputed company is the reputed company for you. Don’t just take our word for it! Hear what our people are saying:“I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals reputed company revolving around helping each other.” – reputed company Specialist “I enjoy working for reputed company because of the Core Values we reputed company in. reputed company stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” – Supervisor, Operations Apply To This Job