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.