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

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.