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Workers' Compensation Specialist-Remote TX Resident Req
GENERAL JOB DESCRIPTION
Handles verification of injury/claim of all WC patients including auditing medical record for billing accuracy. Responsible for marketing to employers/WC clinics and is the point of contact for adjustors and case managers.
ESSENTIAL FUNCTIONS
- 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
- Point of contact for all adjustors and case managers
- Facilitate physician’s use and understanding of ODG
- Prepare DWC 73’s & 69’s
- 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.
QUALIFICATIONS
Education
- High School Diploma
Experience
- Three years medical office WC billing experience
- Knowledge of Texas Workers’ Comp ODG treatment, RTW and fee guidelines
Licensure
Special Skills
- 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
PHYSICAL DEMANDS
- Telephone – with or without headset – constantly
- Photocopier – frequently
- Computer – constantly
- Fax machine – frequently
ENVIORNMENTAL WORKING CONDITIONS
- Indoors with rare conditions of extreme noise.
- Rare conditions of chemicals/fumes/odors and dust/messiness
- Continuously handle multiple tasks simultaneously and work as part of a team.
- Occasionally perform tedious and exacting work in frustrating conditions.
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