Essential Functions:

Initiates contact with WC insurance carriers, Adjusters, and web portals regarding workers' compensation claims on all outstanding bills updating and noting as working. Preparing and submitting claims, while verifying accuracy and revising errors. Initiates appeal preparation with all required documentation and submits appropriately to the insurance carrier. Addresses and updates incorrect demographics for insurance and patient billing. Alerts team and managers of any concerns regarding trends or billing issues as they arise. Posts payment and documents payment records and issues in a timely manner. Scanning and uploading documents and medical records for claims processing and medical records requests. Work required hours set forth for the position.

KNOWLEDGE, SKILLS AND ABILITIES

• Perform timely follow- up for all Workers Compensation and No Fault billing and collection, claim denials, and claim appeals.
• Thorough reviewing of charts and correspondence to determine the merits of the case.
• Draft written responses to address any collections issues Assertive negotiate settlements on the phone and intelligent negotiation skills
• Retrieve authorizations/referrals from insurance companies
• Handle ALL aspects of billing: charge entry, payments, A/R management.
• Prioritize daily tasks while working independently in a fast-paced environment.
• Perform additional duties as requested by Supervisory or Management team.
• Stay up to date on state workman’s compensation guidelines.

• Basic medical terminology related to the cause and treatment of occupational injuries and diseases
• Practices and procedures of claims management including investigation and evaluation
• Knowledge of workman’s compensation billing.
• Telephone, office and online etiquette

· Being a team player, taking instruction well, while also being able to independently function and prioritize workload.

· Proactively seek work to complete and stay aggressive on meeting company expectations.

· Strong experience with all major insurance carriers including in and out of network services.

· Knowledge of Orthopedic and Pain Management coding and bundling rules preferred and basic medical billing and coding a plus.

· Experience with CPT, ICD10, Modifiers and CCI Edits

· Detail oriented and accurate data entry skill · Excellent phone and communication skills

· Must demonstrate interpersonal skills with all levels of billing and management team.

· Basic computer literacy including the ability to utilize Excel spreadsheets.

· Knowledge of computerized EHR scheduling systems.

· Knowledge of HIPAA rules and regulations

· Knowledge of legal and ethical considerations related to patient information

· Knowledge of customer service principles and techniques

· Skill in communicating effectively with physicians/clinicians, staff and patients.

· Skill in putting information in preferred medical records system, meeting clinical standards

·Desirable Traits

Communicates Effectively, Customer Focused, Values and Respects Others, drives to Excel, Teamwork and Collaboration, Continuous Learning, Demonstrates Ethical Behavior, Supportive of Change

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