ACCOUNTS RECEIVABLE SPECIALIST WORKERS COMPEN

PSN Services LLC-posted 1 day ago

Full-time • Mid Level

Plano, TX

501-1,000 employees

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The AR Specialist - Texas Workers' Compensation will manage the complete revenue cycle for workers' compensation surgical claims at our specialty surgical facilities, focusing on spine, orthopedic, ENT, and pain management procedures. This role serves as the primary liaison between our facility and workers' compensation carriers, employers, adjusters, and case managers to expedite claim resolution and optimize reimbursement for services rendered.

Manage surgical workers' comp claims from authorization through payment - Track all workers' compensation surgical cases from initial scheduling through final reimbursement
Collaborate with Verification of Benefits team - Assist in reviewing compensability determinations, confirming active claim status, and identifying red flags that could impact payment
Partner with coding team on documentation - Review operative reports and clinical documentation to ensure medical necessity is clearly established and services are appropriately coded
Expedite claim resolution - Proactively follow up on unpaid claims and work directly with adjusters to resolve payment delays
Build strategic relationships with adjusters at major carriers to facilitate faster claim processing
Coordinate with nurse case managers to ensure surgical procedures are properly authorized
Engage with employer representatives when appropriate to clarify coverage issues or expedite approvals
Serve as facility liaison - Act as primary point of contact for all workers' compensation stakeholders
Maximize reimbursement under Texas fee schedules for surgical procedures, implants, and ancillary services
Appeal underpayments and denials - Identify payments below fee schedule requirements or incorrect surgical reimbursement calculations
Manage stop-loss and outlier provisions for high-cost surgical cases
Track implant and device costs - Ensure proper billing for surgical implants, biologics, and high-cost medical devices
Navigate preauthorization requirements - Work with clinical teams to obtain all required authorizations before surgery
Manage concurrent review requirements for procedures requiring ongoing authorization
Handle peer-to-peer reviews - Facilitate physician discussions to support medical necessity
Ensure timely filing compliance within Texas-mandated timeframes
Spine procedures - Manage complex spine surgery claims including fusions, disc replacements, and neurostimulator implants
Orthopedic surgery - Handle joint replacements, arthroscopic procedures, and fracture repairs
Pain management - Process claims for epidural injections, nerve blocks, and spinal cord stimulator trials/implants
ENT surgical claims - Manage sinus surgeries and other ENT procedures related to workplace injuries
Track carrier-specific payment patterns and denial reasons
Identify process improvement opportunities based on denial patterns
Maintain detailed account notes documenting all payer interactions
Provide regular updates to leadership on workers' comp AR performance

Exceptional relationship-building skills with adjusters, case managers, and employer representatives
Strong collaborative approach working with internal teams (verification, coding, clinical)
Expert knowledge of surgical reimbursement and Texas workers' comp fee schedules
Negotiation and advocacy skills to professionally advocate for appropriate reimbursement
Understanding of surgical procedures in spine, orthopedic, ENT, and pain management
Workers' comp billing expertise including preauthorization and carrier-specific requirements
Problem-solving orientation to identify payment issues and develop solutions
Excellent communication skills with external partners and internal teams
Detail-oriented with strong follow-through and systematic claim tracking
Technology proficiency with practice management systems and workers' comp portals
Customer service mindset understanding employers and adjusters as customers
Minimum 3-5 years of workers' compensation billing experience in a surgical facility setting (ASC or hospital outpatient preferred)
Proven experience working surgical workers' comp claims for spine, orthopedic, or pain management procedures
Demonstrated success building relationships with adjusters and case managers
Experience collaborating with clinical teams for documentation and authorizations
Track record of successful claim resolution including appeals and negotiations
Understanding of surgical fee schedules including implant pass-through calculations

Experience in multi-specialty surgical facilities with high-dollar spine and orthopedic cases (Preferred)
Established relationships with major Texas workers' comp carriers and TPAs (Texas Mutual, Travelers, Sedgwick, Gallagher Bassett, CorVel) (Preferred)
Knowledge of specific surgical authorization requirements for complex procedures (Preferred)
Experience with both in-network and out-of-network negotiations (Preferred)
Understanding of ODG (Official Disability Guidelines) and Milliman care guidelines (Preferred)
Certification in healthcare revenue cycle (CRCR) or workers' compensation (CWCP) (Preferred)
Bilingual (English/Spanish) to communicate with diverse injured worker populations (Preferred)

Competitive salary and performance incentives
Comprehensive benefits package
Paid time off and wellness programs
Career development and training opportunities

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