Workers' Compensation Specialist-Remote TX Resident Req
About The Position
This role is responsible for handling the verification of injuries and claims for all Workers' Compensation (WC) patients, including auditing medical records for billing accuracy. The specialist will also be responsible for marketing to employers and WC clinics, and serving as the point of contact for adjusters and case managers. The position requires staying up-to-date on Texas Department of Workers' Compensation (DWC) rules, including ODG treatment, Return to Work (RTW), preauthorization, and fee guidelines, as well as performing Accounts Receivable (AR) follow-up to ensure claims are paid timely.
Requirements
- 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
- Serve as the point of contact for all adjustors and case managers
- Facilitate physician’s use and understanding of ODG
- Prepare DWC 73’s & 69’s
- Obtain 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
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
