Senior Workers' Compensation Analyst Remote

Harris Computer•Arlington, TN

2d•Remote

About The Position

The Senior Workers' Compensation Specialist, Complex Claims, verifies workers' compensation carrier and claim information and manages billing, follow-up, denials, and appeals through to payment. The role autonomously handles workers' compensation and No-Fault accounts, negotiates with carriers and adjusters, and identifies trends affecting reimbursement. The Specialist works with leadership and their direct manager to improve workflows and streamline operations, maintains Standard Operating Procedures for workers' compensation and No-Fault processes, and serves as a subject-matter expert who mentors and trains less-experienced team members. The ideal candidate is knowledgeable about orthopedic and pain management billing, state workers' compensation guidelines, and major insurance carriers.

Requirements

Knowledge of orthopedic and pain management billing.
Knowledge of state workers' compensation guidelines.
Knowledge of major insurance carriers.

Responsibilities

Verify workers' compensation carrier and claim information before and during billing, including carrier, claim number, date of injury, employer, adjuster contacts, claim status, and accepted body parts or injuries.
Obtain and document authorizations and referrals for scheduled services.
Use carrier phone lines, adjusters, employer contacts, and web portals to verify information, and record findings in patient accounts.
Contact workers' compensation carriers and adjusters about outstanding bills, update accounts, and document accounts as worked.
Prepare and submit claims, verifying accuracy and correcting errors before submission.
Prepare appeals with required documentation and submit them within filing deadlines.
Correct inaccurate demographic and insurance information for insurance and patient billing.
Alert the team and managers to trends, recurring denials, and billing issues.
Work with leadership and the direct manager to identify process gaps, streamline workflows, and improve reimbursement and collection outcomes.
Create, update, and maintain Standard Operating Procedures for workers' compensation and No-Fault processes.
Mentor and train less-experienced team members and serve as the workers' compensation and No-Fault billing expert.
Take ownership of complex and escalated accounts through resolution, using independent judgment within department policies.
Post payments and promptly document payment records and issues.
Scan and upload documents and medical records for claims processing and medical records requests.