Workers' Compensation Specialist

ORTHOLONESTAR • Houston, TX

6d • Onsite

About The Position

Handles verification of injury/claim of all WC patients including auditing medical record for billing accuracy. Responsible for marketing to employers/WC clinics and is the point of contact for adjustors and case managers.

Requirements

• High School Diploma
• Three years medical office WC billing experience
• Knowledge of Texas Workers’ Comp ODG treatment, RTW and fee guidelines
• Excellent computer knowledge and skills
• Ability to effectively communicate both orally and written
• Adequate visual acuity to read written materials
• Ability to sit for long periods of time
• Problem solving skills
• Attention to detail

Responsibilities

• Call adjustors to verify all new and established WC injuries/claims per protocol
• Audit WC appointments for comments/authorization/DWC
• Prepare claims and documentation for filing
• Point of contact for all adjustors and case managers
• Facilitate physician’s use and understanding of ODG
• Prepare DWC 73’s & 69’s
• Authorization of all WC procedures
• Timely Follow up on appeals for unpaid claims utilizing claims maintenance
• Advise physicians on dispute cases including initiating Benefit Review Conferences
• Remain up to date on DWC rules – including ODG treatment, RTW, Preauthorization and fee guidelines
• AR Follow up to ensure claims are paid timely.
• All other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees