Revenue Specialist, Commercial Billing

Position Summary

The Revenue Specialist, Commercial Billing investigates and analyzes Motor Vehicle Accident accounts in order 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 position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.

Key Responsibilities

• Conduct online medical research of Motor Vehicle Accident claim 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 knowledge of account information. Utilizing information to manage claim life cycle and accurately communicate insurance carriers.
• Review accounts take steps to resolve for payment by contacting payers for claim status, rebilling when necessary, and escalating issues when needed.
• Responsible for thorough and timely claim and 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.
• Other duties as required.

Requirements and Qualifications

• High School Diploma or GED required. Associate or bachelor’s Degree preferred.
• 2+ years’ experience in healthcare field working in billing or collections. EMR/Billing system experience required.
• 2+ years’ client facing/customer services experience.
• 1+ years’ experience with Health Insurance/Government Insurance claim resolution required.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements in relation 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.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions.

Special Considerations and Prerequisites

• Practices and adheres to EnableComp’s Core Values, Vision and Mission.
• Proven ability to meet and/or exceed productivity targets and goals.
• Maintains a professional image and provides excellent customer service.
• 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.
• Attend weekly team meetings to discuss updates/changes such as new hospital procedures or current client issues.
• Communicate any issues through the manager including, but not limited to, systems errors, questions for other departments, HIPAA questions.
• Constantly operates a computer and phone.