Resolution Analyst, Denials

About the Company

EnableComp delivers specialty revenue cycle management services for healthcare organizations. With more than 24 years of experience, its E360 RCM intelligent automation platform helps hospitals, health systems, and ambulatory surgery centers improve financial performance across the revenue cycle. The company uses proprietary algorithms, insights built from more than 10 million processed claims, and human-in-the-loop expertise to support claims related to Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, Out-of-State Medicaid, and denials across all payer types. EnableComp’s work is focused on helping clients accelerate cash flow, improve yield accuracy, strengthen accounts receivable management, lower denials, and gain better performance visibility. The company has received the Top Workplaces award multiple times, was named Black Book’s #1 Specialty Revenue Cycle Management Solution provider in 2024, and has been included in the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.

Role Summary

The Resolution Analyst supports the denials and underpayment appeal workflow by serving as a bridge between client contacts and payer-side review teams. The role focuses on recovering revenue from denied and underpaid accounts for assigned clients while safeguarding patient health information and all confidential company and client data.

What You Will Do

• Examine denied, underpaid, outstanding, and other assigned claims, then pursue review, appeal, and follow-up activity using EnableComp’s internal software and tools.
• Interpret payer payment records and provider contract terms to confirm the reimbursement amount that should have been paid.
• Review hospital contracts to identify underpayments and recover funds from insurance carriers.
• Gather relevant medical records and supporting materials needed to prepare and submit detailed underpayment appeals to the correct payer.
• Carry out prompt and detailed phone follow-ups with payers to verify receipt of supporting documents and move claims toward resolution.
• Help maintain smooth workflow and contribute to better customer satisfaction.
• Complete additional duties as needed.

Requirements

• High school diploma or GED is mandatory; an associate degree or bachelor’s degree is preferred.
• At least 5 years of experience in healthcare billing or collections.
• At least 1 year of experience in a client-facing or customer service role.
• Working knowledge of insurance payer and provider claims processing and the related data requirements.
• Comfort using computers and standard office software, including Word, Excel, and Outlook.
• Intermediate familiarity with ICD, HCPCS/CPT coding, and medical terminology.
• Strong grasp of revenue cycle processes.
• Good understanding of hospital reimbursement, managed care contracts, contract language, and applicable federal and state requirements.
• Knowledge of HMO, PPO, IPA, and capitation concepts and how these payers handle claims.
• Working understanding of EOBs, UB-04 hospital billing forms, and HCFA 1500 forms.
• Ability to review contracts and identify complex underpayment issues.
• Regular, dependable attendance is required.
• Must be able to perform the essential job duties, with reasonable accommodations available for qualified individuals with disabilities.

Special Considerations

• Must follow EnableComp’s core values, vision, and mission in daily work.
• Should have a proven record of meeting or exceeding productivity targets.
• Needs to stay effective under pressure and handle stress while preserving strong stakeholder relationships.
• Must be self-directed and capable of working independently without close supervision.
• Strong written and verbal communication skills are necessary.
• Requires solid analytical thinking and problem-solving ability.
• Experience working with external clients, along with strong customer service and business judgment, is important.
• Must be able to balance several priorities and projects at the same time.
• The role requires remaining stationary for about 50% of the work time.
• May occasionally move around the office to access equipment and work areas.
• Will frequently use a computer and other office equipment such as a copier, scanner, printer, and phone.

Equal Opportunity and Hiring Notice

EnableComp is an equal opportunity employer and considers applicants without regard to race, color, religion, national origin, sexual orientation, ancestry, marital status, disability, or veteran status. The company is committed to maintaining a workplace free from discrimination and harassment.

EnableComp also emphasizes employee growth and development, offering a culture focused on professional development, support, and long-term career success. The organization highlights teamwork, shared goals, flexibility, and balance between work and personal life as part of its workplace values.

The company may use artificial intelligence tools during parts of the hiring process, such as reviewing applications, screening resumes, or checking responses for potential inconsistencies or verification signals. These tools assist recruiters but do not replace human judgment, and final hiring decisions are made by people. Candidates seeking more information about data processing can contact the company directly.