[Hiring] Workers' Compensation Specialist @ORTHOLONESTAR

Role 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

• High School Diploma
• Three years 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

• Telephone – with or without headset – constantly
• Computer – constantly

Environmental 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