Occupational Health - Occupational Health Claims & Revenue Cycle Specialist - FT - 1st Shift

Wilson Health•Sidney, OH

12d•Onsite

About The Position

Wilson Health is seeking an organized, detail-oriented professional to support workers’ compensation claims administration, occupational health services, care coordination, medical billing, coding, and revenue cycle operations. The Specialist coordinates claims, manages medical documentation, processes billing and reimbursement activities, and facilitates communication among healthcare providers, employers, insurance carriers, Managed Care Organizations (MCOs), attorneys, and injured workers. The role manages workers’ compensation claims from initial injury reporting through treatment and resolution; reviews and submits claims documentation; tracks claim status and deadlines; coordinates follow-up care and referrals; and supports continuity of care. It also generates invoices, reviews clinical documentation and coding, prepares and submits claims, resolves billing errors and denials, and coordinates with providers and payers to support accurate reimbursement. The Specialist serves as a point of contact for stakeholders, processes authorized medical records requests, and provides administrative support for documentation and departmental workflows. The position is full-time, 40 hours per week (80 hours per pay period), on the first shift, at Wilson Health in Sidney, Ohio. It reports to the Occupational Health Manager and has no direct supervisory responsibilities. The work is primarily in an office with low-to-moderate noise, regular computer and telephone use, and occasional movement throughout the hospital to retrieve, distribute, or coordinate documentation. Physical activities may include sitting, standing, walking, typing, reaching, bending, and occasionally lifting or carrying light items.

Requirements

High school diploma or equivalent.
Three years of experience in healthcare billing, revenue cycle management, workers’ compensation administration, claims processing, occupational health, or a related healthcare field.
Working knowledge of medical terminology, anatomy and physiology, and medical coding principles, including CPT, HCPCS, and ICD-10.
Experience working with insurance carriers, Managed Care Organizations, workers’ compensation claims, or healthcare reimbursement processes.
Proficiency with Microsoft Office applications and electronic medical record systems.
Strong organizational skills and ability to manage multiple priorities, competing deadlines, and complex workflows.
Excellent written and verbal communication skills.
Strong analytical, problem-solving, and critical-thinking abilities.
Exceptional attention to detail and commitment to accuracy.
Ability to maintain confidentiality and exercise discretion with sensitive medical and claims information.
Ability to work independently and collaborate effectively with internal and external stakeholders.
Knowledge of workers’ compensation claims processes, regulatory requirements, and reimbursement procedures.
Understanding of healthcare billing, coding, charge capture, and revenue cycle operations.
Ability to interpret clinical documentation and identify missing or incomplete information.
Strong communication and customer service skills when working with providers, employers, insurers, attorneys, and injured workers.
Ability to manage detailed documentation, competing priorities, and time-sensitive submissions.
Commitment to accuracy, regulatory compliance, confidentiality, and continuous improvement.

Nice To Haves

Associate degree in Healthcare Administration, Health Information Management, Business Administration, Medical Billing and Coding, or a related field.
Professional certification such as Certified Professional Coder (CPC), Certified Coding Associate (CCA), Certified Billing and Coding Specialist (CBCS), Registered Health Information Technician (RHIT), or equivalent credential.
Experience with Ohio Bureau of Workers’ Compensation (BWC) claims administration.
Previous experience in Occupational Health, Employee Health, Revenue Cycle, or Workers’ Compensation services.
Knowledge of CMS-1500 and UB-04 claim forms, electronic claim submission processes, and healthcare reimbursement methodologies.
Experience with Quadax, Xpeditor, Systoc EDI, or comparable billing and claims management platforms.

Responsibilities

Manage workers’ compensation claims from initial injury reporting through ongoing treatment and claim resolution.
Review injury reports, medical records, treatment notes, and supporting documentation for accuracy, completeness, and compliance.
Process and distribute workers’ compensation forms, including C-9 treatment requests, MEDCO-14 forms, work status reports, imaging reports, and follow-up visit documentation.
Submit required documentation to the Ohio Bureau of Workers’ Compensation (BWC), MCOs, employers, attorneys, and other authorized parties.
Monitor claim status, track submission deadlines, and follow up on missing information.
Maintain accurate and confidential claim records in accordance with regulations and organizational policies.
Coordinate follow-up medical care after Emergency Department, Urgent Care, and Occupational Health visits.
Schedule appointments and coordinate referrals to specialists, diagnostic services, physical therapy, and other healthcare providers.
Facilitate communication about treatment plans, authorizations, work restrictions, and return-to-work status.
Monitor referral outcomes and assist with continuity of care.
Help injured workers understand appointment requirements, follow-up care, and workers’ compensation procedures.
Generate and process invoices for occupational health services, employer-based clinics, executive physicals, and other applicable services.
Review clinical documentation and apply appropriate CPT, HCPCS, ICD-10, and revenue codes to support accurate billing and reimbursement.
Prepare and review CMS-1500 and UB-04 claim forms, as applicable.
Review procedure documentation for accurate charge capture of examinations, wound care, injections, laboratory services, imaging, testing, supplies, and other billable services.
Build, review, and process workers’ compensation billing batches and electronic claim submissions.
Submit electronic claims through established billing platforms and resolve submission errors or incomplete billing information.
Coordinate commercial insurance billing and respond to payer requests for supporting documentation.
Identify and help resolve billing discrepancies, claim denials, and reimbursement delays.
Collaborate with providers and clinical staff to obtain documentation needed for accurate coding, charge capture, and reimbursement.
Serve as a primary contact for employers, insurance carriers, MCOs, healthcare providers, BWC representatives, attorneys, and injured workers.
Respond to inquiries about claim status, treatment authorizations, medical documentation, billing, and reimbursement.
Coordinate the exchange of medical and claims information in accordance with privacy regulations.
Process authorized medical records requests and compile supporting documentation for legal proceedings when appropriate.
Maintain positive working relationships through timely communication, professionalism, and customer service.
Retrieve, organize, and distribute incoming mail and time-sensitive documentation.
Route billing, payment, reimbursement, and workers’ compensation paperwork to the appropriate departments.
Coordinate delivery and processing of imaging registration paperwork and other required clinical documentation.
Ensure medical records, billing documents, and claims information are distributed accurately and promptly.
Maintain organized records and support efficient departmental workflows.

Benefits

Access to an Employer Direct Care Clinic, including free medical care and pharmacy services for eligible employees and dependents covered by Wilson Health’s medical insurance plan.
Generous paid time off program beginning on day one.
Choice of two High-Deductible Health Plan (HDHP) options or a PPO medical plan, along with dental and vision coverage; benefits begin on the first of the month following hire.
Health Savings Account (HSA) with employer contribution for eligible health plans and a Flexible Spending Account (FSA) for medical and dependent care expenses.
Company-paid life insurance and long-term disability insurance.
Voluntary accident, critical illness, and employee and dependent life and AD&D insurance.
Retirement plan with employer contributions beginning on day one, with no waiting period for participation.
Tuition Assistance Program.
Free access to an on-site gym available 24/7.
10% discount on food and beverages at the Wilson Cafeteria, Coffee Bar, and Micro Mart.