Medical Billing/ Appeals Specialist - Workers Compensation- Hybrid
Description
REMOTE - this position will be fully remote after training. **Texas residents only***
Job purpose
The Appeals/Workers’ Compensation Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment.
Duties and responsibilities
· Reviews and appeal unpaid and denied worker’s compensation claims
· Attaches appropriate documents to appeal letters
· Obtains pre-authorization for worker’s compensation office visits and procedures
· Researches and evaluates insurance payments and correspondence for accuracy
· Logs appeals and grievances, and tracks progress of claims
· Keeps up-to-date reports and notates any trends pertaining to insurance denials
· Calls insurance companies to inquire about claims, refund requests and payments
· Utilizes EMR system to submit and correct claims
· Posts patient and insurance payments
· Sends paper claims to insurance carriers
· Answers patient billing questions
· Coordinates medical and billing records payments with patients and/or third party payers
· Handles collections on unpaid accounts
· Identifies and resolves patient billing complaints
· Answers phone calls to the Billing Department in a timely and professional manner
· Processes credit card payments over the phone and in person
· Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
· Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
· Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
· Has regular and predictable attendance
· Adheres to Advanced Pain Care’s Policies and procedures
· Performs other duties as assigned
Requirements
Education: Requires a high school diploma or GED; workers’ compensation adjuster license desired
Experience: Three or more years related work experience of training; previous job experience in worker’s compensation
Knowledge, Skills and Abilities:
· Clear and precise communication
· Ability to pay close attention to detail
· Effectively manages day by organizing and prioritizing
· Possesses excellent phone and customer service skills and abilities
· Protects patient information and maintains confidentiality
· Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding
· Familiarity with analyzing electronic remittance advice and electronic fund transfers
· Experience interpreting zero pays and insurance denials
· Competence in answering patient questions and concerns about billing statements
· Organizational skills and ability to identify, analyze and solve problems
· Works well independently as well as with a team
· Strong written and verbal communication skills
· Interpersonal/human relations skills
Working conditions
Environmental Conditions: Medical Office environment
Physical Conditions:
· Must be able to work as scheduled – typically from 8:00 – 5:00 M-F
· Must be able to sit and/or stand for prolonged periods of time
· Must be able to bend, stoop and stretch
· Must be able to lift and move boxes and other items weighing up to 30 pounds.
· Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.
Apply To This Job
REMOTE - this position will be fully remote after training. **Texas residents only***
Job purpose
The Appeals/Workers’ Compensation Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment.
Duties and responsibilities
· Reviews and appeal unpaid and denied worker’s compensation claims
· Attaches appropriate documents to appeal letters
· Obtains pre-authorization for worker’s compensation office visits and procedures
· Researches and evaluates insurance payments and correspondence for accuracy
· Logs appeals and grievances, and tracks progress of claims
· Keeps up-to-date reports and notates any trends pertaining to insurance denials
· Calls insurance companies to inquire about claims, refund requests and payments
· Utilizes EMR system to submit and correct claims
· Posts patient and insurance payments
· Sends paper claims to insurance carriers
· Answers patient billing questions
· Coordinates medical and billing records payments with patients and/or third party payers
· Handles collections on unpaid accounts
· Identifies and resolves patient billing complaints
· Answers phone calls to the Billing Department in a timely and professional manner
· Processes credit card payments over the phone and in person
· Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
· Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
· Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
· Has regular and predictable attendance
· Adheres to Advanced Pain Care’s Policies and procedures
· Performs other duties as assigned
Requirements
Education: Requires a high school diploma or GED; workers’ compensation adjuster license desired
Experience: Three or more years related work experience of training; previous job experience in worker’s compensation
Knowledge, Skills and Abilities:
· Clear and precise communication
· Ability to pay close attention to detail
· Effectively manages day by organizing and prioritizing
· Possesses excellent phone and customer service skills and abilities
· Protects patient information and maintains confidentiality
· Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding
· Familiarity with analyzing electronic remittance advice and electronic fund transfers
· Experience interpreting zero pays and insurance denials
· Competence in answering patient questions and concerns about billing statements
· Organizational skills and ability to identify, analyze and solve problems
· Works well independently as well as with a team
· Strong written and verbal communication skills
· Interpersonal/human relations skills
Working conditions
Environmental Conditions: Medical Office environment
Physical Conditions:
· Must be able to work as scheduled – typically from 8:00 – 5:00 M-F
· Must be able to sit and/or stand for prolonged periods of time
· Must be able to bend, stoop and stretch
· Must be able to lift and move boxes and other items weighing up to 30 pounds.
· Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.
Apply To This Job