[Hiring] Workers Compensation Claims Representative @Elevate Patient Financial Solutions

Role Description

Elevate Patient Financial Solutions is seeking detail-oriented and proactive professionals to join our team as a Workers Compensation Claims Representative. This remote, full-time opportunity offers a consistent schedule of Monday through Friday from 8:00 AM to 5:00 PM. In this role, you’ll play a key part in helping hospitals and medical providers get paid for care as a result of work-related injuries. You’ll gather important workers’ compensation details and insurance information by working closely with hospitals, employers, patients, and other sources. You’ll also handle submitting claims and documentation to insurance carriers, reviewing payments and denials, and writing appeals when needed.

The purpose of this position is to assist hospitals and medical providers in resolving accounts that are a result of work-related injuries. Specifically, this position is focused on:

• Obtaining Workers’ Compensation injury details and insurance information from various sources.
• Submission of insurance bills and documentation to Workers’ Compensation insurance carriers.
• Review of payments and denials for potential appeal.
• Writing and submitting appeals.
• Communication with insurance carriers, employers, attorneys, and patients during the claims adjudication process.

Qualifications

• High School Diploma or GED.
• Some college coursework preferred.
• Positive and encouraging attitude.
• Strong customer service background.
• Professional, accurate, clear, and concise communication, both verbal and written.
• Detailed and thorough.
• Adaptable.
• Organized and excel in time management.
• Proven ability to be assertive in order to proactively resolve issues.
• Demonstrated ability to organize and set priorities according to changing situations and demands.
• Ability to add, subtract, multiply, and divide in all units of measure.
• Required computer skills: experience with data entry and word processing, capable of operating routine office equipment, working knowledge of MS Office applications, and understanding how to navigate web-based applications.
• 1-5 years of related experience in fields such as medical billing and coding, medical appeals, claims adjudication, insurance, workers’ compensation, or legal work.

Requirements

• Maintain a queue of Workers’ Compensation accounts as assigned by management.
• Maintain quality and productivity levels set by management once full job proficiency has been achieved.
• Contact patient’s employer, Workers’ Compensation carrier, and injured worker via telephone and mail to obtain injury information and insurance information.
• Support patients by answering any questions about the Workers’ Compensation process.
• Coordinate with appropriate client personnel to ensure appropriate filing guidelines are met for reimbursement.
• Request appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition.
• Perform manual data entry of patient accounts and/or claim forms.
• Submit hospital and physician bills to insurance companies for payment.
• Maintain contact with insurance adjusters/carriers, employers, and patients during the claim adjudication process.
• Obtain claim status and gather supporting documentation to submit appeals.
• Make written or verbal appeals to payers on denied claims.
• Provide strong customer service to clients and provide responses to client inquiries within 24 hours.
• Provide detailed updates to Elevate PFS’s account management system and hospital/provider practice management system.
• Assist in training both new and existing employees.
• Escalate complex accounts to management to ensure accounts are progressing effectively.
• Identify and discuss root cause issues with management.
• Maintain and update proper account documents in multiple systems.
• Assist management with ad hoc inventory initiatives and other projects, as needed.
• Review and manage patient accounts to ensure proper documentation, payments, and necessary letters of authorization are entered correctly.
• Maintain and adhere to compliance policies and procedures.
• Other duties as assigned.

Benefits

• Medical, Dental & Vision Insurance.
• 401K (100% match for the first 3% & 50% match for the next 2%).
• 15 days of PTO.
• 7 paid Holidays.
• 2 Floating holidays.
• 1 Elevate Day (floating holiday).
• Pet Insurance.
• Employee referral bonus program.
• Teamwork: We believe in teamwork and having fun together.
• Career Growth: Gain great experience to promote to higher roles.