Revenue Specialist, Commerical Billing, MVA (REMOTE)

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp delivers solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes.

About the Role

The Revenue Specialist, Commercial Billing investigates and analyzes Motor Vehicle Accident accounts to properly identify and coordinate insurance benefits and resolve outstanding balances for our clients. This position acts as the liaison between EnableComp clients, patient attorneys, and insurance companies. This role involves handling patient health information (PHI) and requires maintaining extreme privacy and security regarding confidential and proprietary information.

Responsibilities

• Conduct online medical research of Motor Vehicle Accident claims and Health Insurance claims using EnableComp’s proprietary software, systems, and tools, as well as other online medical websites.
• Research, request, acquire, and review medical records, provider notes, explanation of benefits, and any other supporting documentation necessary for account knowledge. Use this information to manage the claim life cycle and accurately communicate with insurance carriers.
• Review accounts and take steps to resolve for payment by contacting payers for claim status, rebilling when necessary, and escalating issues as needed. Ensure thorough and timely claim resolution for HI/GI account receivables.
• Review and resolve denied claims by submitting corrected claims and filing appeals.
• Communicate with various parties to discuss coordination of insurance benefits, claim status, and additional needs to facilitate claim adjudication.
• Review and analyze health insurance remittance to ensure proper claim adjudication; work with payers to resolve underpayments. Identify and alert leadership of denial trends to assist in denial prevention efforts.
• Attend weekly team meetings to discuss updates/changes such as new hospital procedures or current client issues.
• Communicate any issues through the manager, including systems errors, questions for other departments, or HIPAA-related inquiries.
• Perform other duties as required.

Requirements

• High School Diploma or GED required; Associate or Bachelor’s Degree preferred.
• 2+ years of experience in the healthcare field working in billing or collections. EMR/Billing system experience required.
• 2+ years of client-facing/customer service experience.
• 1+ years of experience with Health Insurance/Government Insurance claim resolution required.
• Strong computer proficiency, including MS Office (Word, Excel, and Outlook).
• Intermediate-level understanding of insurance payer/provider claims processing and data requirements related to motor vehicle claims.
• Intermediate-level understanding of Health Insurance/Government insurance claims processing.
• Basic-level understanding of MVA legal requirements.
• An equivalent combination of education and experience will be considered.
• Regular and predictable attendance.

Skills

• Proven ability to meet and/or exceed productivity targets and goals.
• Maintains a professional image and provides excellent customer service.
• Stable performance under pressure or opposition; handles stress while maintaining relationships with stakeholders.
• Self-starter able to work independently without direct supervision.
• Strong written and verbal communication skills.
• Strong analytical and problem-solving skills.
• Proven experience working with external clients; strong customer service skills and business acumen.
• Constant operation of a computer and phone.