Worker’s Comp Medical Biller

Title: Worker's Comp Medical Biller
Reports to: Occupational Medicine Supervisor
FLSA Classification: Hourly Non-Exempt

Commonwealth Pain & Spine is a pain management network dedicated to improving the lives of our patients by treating their pain with the utmost respect and providing them with the most innovative, safe, responsible, and clinically proven pain relief possible.
Our team of best-in-class physicians, administrators, and staff empathizes with the needs of our patients. We recognize that their pain is exhausting and debilitating and limits their quality of life. Relief from chronic pain is achievable in various degrees through our intelligent and multimodal team-based approach. Our entire team is committed to providing levels of patient satisfaction and overall clinical outcomes that far exceed the expectations of the medical community, referring physicians, and our customers.

Benefits:

• Competitive compensation
• Comprehensive Health/Vision/Dental insurance options
• Great PTO plan PLUS Paid Holidays
• 401k and matching available

Commonwealth Pain and Spine is an Equal Employment Opportunity Employer!

Job Summary:
The Billing Specialist ensures accurate processing of medical charges, insurance verification, claim submission, and denial management. Responsibilities include posting daily E/M charges, resolving unpaid or denied claims, maintaining billing documentation, and assisting patients with account inquiries. This role requires strong communication, problem-solving, and customer service skills, along with the ability to analyze denial trends, implement corrective actions, and support process improvements in a fast-paced environment.

• Post daily Evaluation and Management (E/M) charges
• Verify Insurance.
• Post charges.
• Track, fix, rebill and fllow-up on unpaid claims.
• Contact insurance companies regarding denials.
• Accurately utilize the billing system
• Responsible for managing phone calls and voicemails for billing
• Send medical records for claims as well as insurance audits
• Appeal claims if necessary.
• Assist patients with billing and account questions in a professional manner.
• Provides excellent customer service to employees, vendors, contractors, and guests.
• Responds timely to requests, emails, voicemails, etc.
• Researches and analyzes denial data and coordinates denial recovery responsibilities and report findings to leadership.
• Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denial.
• Identifies and pursues opportunities for improvements in denial performance.
• Processes work lists to facilitate prompt intervention of insurance denials.
• Research, responds, and documents insurer and patient correspondence/inquiry notes regarding coding coverage, benefits, and reimbursement on patient accounts.
• Research rejections included in EOBs for resolution and files appropriately.
• Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks.
• Access necessary online portals to obtain payment documentation.
• Meets monthly, quarterly, and annual goals set forth by the Occupational Medicine Supervisor.
• Communicate effectively and professionally with team members and facilities to obtain information necessary to post payments accurately.
• Maintain confidentiality of patient care and business.
• Prioritizes activities to work overturns in a timely manner to alleviate untimely filings.
• Maintains an approachable and appropriate attitude when interacting with all levels of personnel in a rapidly changing environment.
• Eagerness and ability to work independently as well as part of a team with flexibility and willingness to learn and take initiative on variety of tasks and projects.
• Supports the vision and culture of the organization. Demonstrates personal commitment through active involvement in the performance improvement process.
• Adheres to the Employee Handbook and Policies and Procedures.
• All other duties assigned including duties performed for affiliates, assigns, lessees, contractors or other third parties.

• Requires a minimum of two years’ relevant work experience in medical billing.
• Two years of Workers Compensation medical billing experience preferred.
• Knowledge of insurance plans and their rules specific to Workers Compensation.
• Knowledge of ICD 10 and CPT codes.
• Experience with Athena software a plus!
• Have computer literacy skills and knowledge of Microsoft office applications to include MS Excel, MS Word and MS Outlook.
• Provide excellent customer service.

Education:

• High school diploma or general education degree. (GED)

Physical Requirements:
The physical demands of this position will include sitting and standing with occasional light to medium lifting. An employee must meet these requirements to successfully perform the essential duties of this job. Reasonable accommodation will be made in accordance with ADA rules and regulations.