General Job Description

The Workers' Compensation (WC) Specialist handles verification of injury/claim of all WC patients including auditing medical records for billing accuracy. The position is 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
• Three years of medical office WC billing experience.
• Knowledge of Texas Workers’ Comp ODG treatment, RTW and fee guidelines.
• 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

• Must be able to operate a general computer (constantly), fax (frequently), copier (frequently) and telephone (constantly).
• Position is remote but candidate must be based in Texas as position may require time in office occasionally.

Benefits include a weekday schedule, medical insurance plan options, and a 401k retirement plan with profit sharing.