EnableComp Benefits Overview

Review post-billed inpatient claims to validate DRG accuracy and identify missed reimbursement opportunities. Analyze medical records and coding (ICD-10-CM/PCS), use DRG grouping software and system edits, recommend reimbursement improvements, collaborate on prioritization, and maintain PHI security while meeting high-volume productivity and reporting requirements.

Ensure accurate submission and adjudication of Medicaid claims: verify eligibility, analyze payments, obtain and submit medical records and UB-04 billing packets, follow up with payers, appeal denials/underpayments, handle PHI per HIPAA, manage inbound/outbound calls, and collaborate to meet productivity and reimbursement goals.

Provides executive leadership for EnableComp’s Denials and Revenue Recovery business, including Zero Balance Recovery, appeals, collections, financial performance, operational execution, and growth. The role sets strategy, budgets, recovery targets, staffing plans, and profitability objectives; partners with Product, Technology, Finance, Sales, and Client Success; supports strategic clients; ensures healthcare revenue-cycle compliance; and builds a high-performing leadership organization.