Medical Billing Specialist

Job Advert: Senior AR Specialist – Workers' Comp, PIP, & No-Fault ClaimsAre You a Claims-Juggling Expert? Master the Revenue of the Most Complex Medical Billing Systems![Your Company Name] is a rapidly growing leader in [Your Industry/Specialty, e.g., Orthopedics, Physical Therapy, Revenue Cycle Management]. We are seeking a highly skilled and analytical AR Specialist to join our team, focusing exclusively on the challenging and lucrative Accounts Receivable (AR) for Workers' Compensation (WC), Personal Injury Protection (PIP), and No-Fault claims.If you thrive on uncovering denied revenue, navigating state-specific fee schedules, and closing out high-dollar, multi-party claims, this role is for you.What You'll Do: The Core MissionYou will be the final authority and lead executor for our most complex and high-value AR accounts. Your primary mission is to ensure maximum, timely reimbursement for services rendered under WC, PIP, and No-Fault guidelines.

• Aggressive Claims Follow-Up: Manage a specialized aging report, prioritizing accounts based on value and timely filing limits for WC, PIP, and No-Fault claims.
• Denial Management & Appeals: Investigate and resolve all claim denials, including those related to compensability, medical necessity, pre-authorization, and state fee schedule discrepancies. Draft and submit formal first- and second-level appeals.
• Fee Schedule Mastery: Expertly read, interpret, and apply state-specific Workers' Compensation Fee Schedules and No-Fault state regulations to ensure accurate payment.
• Payer Communication: Maintain professional, results-driven communication with WC Adjusters, PIP Carriers, and legal firms to push claims to final payment or settlement.
• Coordination of Benefits (COB): Navigate complex scenarios where WC and PIP are secondary to each other or another insurance, ensuring proper balance-billing rules are followed.

What You'll Bring: Essential Qualifications

• 3+ years of dedicated, hands-on experience managing Accounts Receivable for Workers' Compensation and/or Personal Injury Protection (PIP)/No-Fault medical claims.
• In-depth knowledge of at least one major No-Fault state (e.g., NY, FL, MI, NJ) regulations and their corresponding medical fee schedules.
• Proven ability to successfully overturn denied claims and reduce days in AR for complex payer groups.
• Strong understanding of medical terminology, CPT/ICD-10 codes, and their impact on claims adjudication.
• Exceptional organizational skills and the ability to manage a high-volume pipeline of complex cases with detailed documentation.

Job Type: Full-time

Pay: Rs60,000.00 - Rs80,000.00 per month

Work Location: In person