Job Details

Job Type

Full-time

Description

REMOTE - this position will be fully remote after training. **Texas residents only***

Job purpose

The Appeals/Workers' Compensation Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment.

Duties and responsibilities

• Reviews and appeal unpaid and denied worker's compensation claims

• Attaches appropriate documents to appeal letters

• Obtains pre-authorization for worker's compensation office visits and procedures

• Researches and evaluates insurance payments and correspondence for accuracy

• Logs appeals and grievances, and tracks progress of claims

• Keeps up-to-date reports and notates any trends pertaining to insurance denials

• Calls insurance companies to inquire about claims, refund requests and payments

• Utilizes EMR system to submit and correct claims

• Posts patient and insurance payments

• Sends paper claims to insurance carriers

• Answers patient billing questions

• Coordinates medical and billing records payments with patients and/or third party payers

• Handles collections on unpaid accounts

• Identifies and resolves patient billing complaints

• Answers phone calls to the Billing Department in a timely and professional manner

• Processes credit card payments over the phone and in person

• Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements

• Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments

• Operates standard office equipment (e.g. copier, personal computer, fax, etc.).

• Has regular and predictable attendance

• Adheres to Advanced Pain Care's Policies and procedures

• Performs other duties as assigned

Requirements

Education : Requires a high school diploma or GED; workers' compensation adjuster license desired

Experience : Three or more years related work experience of training; previous job experience in worker's compensation

Knowledge, Skills and Abilities:

• Clear and precise communication

• Ability to pay close attention to detail

• Effectively manages day by organizing and prioritizing

• Possesses excellent phone and customer service skills and abilities

• Protects patient information and maintains confidentiality

• Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding

• Familiarity with analyzing electronic remittance advice and electronic fund transfers

• Experience interpreting zero pays and insurance denials

• Competence in answering patient questions and concerns about billing statements

• Organizational skills and ability to identify, analyze and solve problems

• Works well independently as well as with a team

• Strong written and verbal communication skills

• Interpersonal/human relations skills

Working conditions

Environmental Conditions : Medical Office environment

Physical Conditions :

• Must be able to work as scheduled - typically from 8:00 - 5:00 M-F

• Must be able to sit and/or stand for prolonged periods of time

• Must be able to bend, stoop and stretch

• Must be able to lift and move boxes and other items weighing up to 30 pounds.

• Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.

Salary Description

$20.00 - $25.00/ hour