Workers' Compensation Specialist

Job Details: Level: Experienced, Job Location: Houston, TX 77030, Position Type: Full Time, Education Level: High School/GED, Salary Range: $19.00 - $23.00, Job Category: Health Care,

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

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.