Workers Compensation Lead

Capitol Imaging Services•Nashville, TN

About The Position

The Worker’s Compensation RCM Lead is responsible for optimizing the healthcare billing lifecycle to ensure accurate, timely reimbursement. The role serves as a key liaison between internal teams, vendor partners, insurance payers, and patients, with a focus on denial resolution, accounts receivable aging follow-up, and revenue integrity. The Lead works to maximize cash flow while ensuring compliance with payer requirements and organizational policies, and oversees, trains, and mentors the WC RCM team. The position is full-time and located at Capitol Imaging Nashville in Nashville, Tennessee. Salary range is undisclosed.

Requirements

High school diploma or equivalent.
At least 5 years of experience in medical billing and collections.
At least 5 years of experience in accounts receivable or revenue cycle management.
At least 5 years of experience in healthcare payer follow-up and denial resolution.
Lead or supervisory experience in a revenue cycle management setting.
Proficiency with Practice Management Systems and Electronic Health Records (EHR/EMR).
Strong working knowledge of Microsoft Office, particularly Excel for reports and aging analysis, and SharePoint.
Working knowledge of medical terminology, CPT and ICD-10 coding, and payer guidelines and reimbursement rules for workers’ compensation payers.
Strong analytical and problem-solving skills.
Exceptional attention to detail and accuracy.
Effective written and verbal communication skills.
Ability to collaborate with internal teams and external vendor partners.
Sound judgment related to financial adjustments and account resolution.

Nice To Haves

Associate’s or bachelor’s degree in Healthcare Administration, Accounting, or a related field.

Responsibilities

Oversee daily billing and collection activity and ensure staff have appropriate tools for maximum productivity.
Prepare, review, and submit medical records and billing claims to the appropriate payer.
Ensure procedures were approved by the adjuster or referring payer.
Verify patient and case information, ensure required documentation is complete, and follow up on unpaid or denied claims within required timeframes.
Adhere to HIPAA, legal ethics rules, and internal data security policies, and maintain confidentiality of client and patient information.
Monitor accounts receivable, reconcile billing records, identify opportunities for payment recovery, and track claims from service date through final resolution and payment.
Balance work between the Lead and other staff members to ensure priority accounts are worked first.
Review aged workers’ compensation accounts receivable (30, 60, 90, and 120+ days) on a structured weekly and monthly schedule.
Follow up regularly with insurance adjusters and carriers regarding claim status and payment details.
Respond promptly to patients, adjusters, and workers’ compensation carriers regarding billing, payments, and claim status.
Coordinate with the cash posting team to ensure accurate posting and reconciliation of insurance and patient payments.
Transfer payments to patient balances when appropriate and notify cash posting about patient refunds in compliance with policy.
Assist with account reconciliations and discrepancy resolution as needed.
Act as a liaison between patients and insurance payers to resolve billing questions.
Explain Explanation of Benefits, patient responsibility, and out-of-pocket costs.
Communicate professionally and empathetically by phone with patients and payer representatives.
Oversee, train, and mentor the workers’ compensation RCM team.