Medical Billing/ Appeals Specialist - Workers Compensation- Hybrid

Advanced Pain Care•Austin, TX

55d•Hybrid

About The Position

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

Requires a high school diploma or GED; workers’ compensation adjuster license desired
Three or more years related work experience of training; previous job experience in worker’s compensation
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
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.

Nice To Haves

workers’ compensation adjuster license desired

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