Workers' Compensation Specialist

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
• Computer – constantly

ENVIORNMENTAL WORKING CONDITIONS

• Remote in your home with potential request to be in office on occasion.
• Continuously handle multiple tasks simultaneously and work as part of a team.
• Occasionally perform tedious and exacting work in frustrating conditions.