Experienced Workers Compensation Remote Claims Rep - (Prior Workers Comp Experience Required) Virtual Hiring Event
Full-time 8 hours ago Full Job Description Elevate PFS Holdings Inc.
has an exciting career opportunity available as a Remote Workers' Compensation Representative.
The Full Time/Part Time schedule for this role will be Monday-Friday with specific business hours TBD within your time zone.
SUMMARY 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 the effort to obtain Workers' Compensation injury details and insurance information from hospital, employers, patients and from other sources; submission of insurance bills and documentation to Workers' Compensation insurance carriers; review of payments and denials for potential appeal; writing and submitting appeals; and communication with insurance carriers, employers, attorneys and patients during the claims adjudication process to ensure that the hospital and/or medical providers receive appropriate payment on submitted bills and denied claims.
ESSENTIAL DUTIES AND RESPONSIBILITIES 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 to ensure that the hospital and physician bills are paid timely and in full.
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 MedData's account management system and hospital/provider practice management system as account work is completed.
Assist in training both new and existing employees, which may include contributing specific training material.
Escalate complex, complicated or challenging accounts to management to ensure accounts are progressing effectively.
Identify and discuss root cause issues with management.
Maintain and updates 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 that proper documentation, payments, and necessary letters of authorization are entered correctly.
Maintain and adhere to compliance policies and procedures Other duties as assigned.
QUALIFICATIONS AND REQUIREMENTS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or abilities.
High School Diploma or GED is preferred except where required by our client Some college coursework preferred Positive and encouraging attitude Strong customer service background Professional, accurate, clear and concise communication, both verbal and written, including the ability to write routine business correspondence Detailed and thorough Adaptable Organized and excel in time management.
Ability to manage and move quickly and accurately through a large workload 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, using whole numbers, common fractions, and decimals.
Required computer skills:
must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications 1-5 years of related experience in the field or in a related area such as:
Medical billing and coding Medical appeals Claims Adjudication Insurance Workers' Compensation Legal work FOR REMOTE WORKERS MUST HAVE:
Consistent and reliable high-speed internet Private work area Ability to secure protected health information Ability to remain on task with remote supervision The duties listed above are intended only as illustrations of the various types of work that may be performed.
The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Elevate Patient Financial Solutions is an Equal Opportunity Employer What to prepare Please ensure your resume is attached to your profile! Review the company website and job description in detail.
Preferred dress code Business casual (dress pants/skirt, button down/blouse, optional tie) What is a virtual interview? Virtual interviews help employers connect with job seekers when they are not in the same physical location.
Since hiring is a human process, employers would like to talk with you online (chat, video or phone) to see if you meet the requirements for the job.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
has an exciting career opportunity available as a Remote Workers' Compensation Representative.
The Full Time/Part Time schedule for this role will be Monday-Friday with specific business hours TBD within your time zone.
SUMMARY 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 the effort to obtain Workers' Compensation injury details and insurance information from hospital, employers, patients and from other sources; submission of insurance bills and documentation to Workers' Compensation insurance carriers; review of payments and denials for potential appeal; writing and submitting appeals; and communication with insurance carriers, employers, attorneys and patients during the claims adjudication process to ensure that the hospital and/or medical providers receive appropriate payment on submitted bills and denied claims.
ESSENTIAL DUTIES AND RESPONSIBILITIES 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 to ensure that the hospital and physician bills are paid timely and in full.
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 MedData's account management system and hospital/provider practice management system as account work is completed.
Assist in training both new and existing employees, which may include contributing specific training material.
Escalate complex, complicated or challenging accounts to management to ensure accounts are progressing effectively.
Identify and discuss root cause issues with management.
Maintain and updates 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 that proper documentation, payments, and necessary letters of authorization are entered correctly.
Maintain and adhere to compliance policies and procedures Other duties as assigned.
QUALIFICATIONS AND REQUIREMENTS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or abilities.
High School Diploma or GED is preferred except where required by our client Some college coursework preferred Positive and encouraging attitude Strong customer service background Professional, accurate, clear and concise communication, both verbal and written, including the ability to write routine business correspondence Detailed and thorough Adaptable Organized and excel in time management.
Ability to manage and move quickly and accurately through a large workload 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, using whole numbers, common fractions, and decimals.
Required computer skills:
must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications 1-5 years of related experience in the field or in a related area such as:
Medical billing and coding Medical appeals Claims Adjudication Insurance Workers' Compensation Legal work FOR REMOTE WORKERS MUST HAVE:
Consistent and reliable high-speed internet Private work area Ability to secure protected health information Ability to remain on task with remote supervision The duties listed above are intended only as illustrations of the various types of work that may be performed.
The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Elevate Patient Financial Solutions is an Equal Opportunity Employer What to prepare Please ensure your resume is attached to your profile! Review the company website and job description in detail.
Preferred dress code Business casual (dress pants/skirt, button down/blouse, optional tie) What is a virtual interview? Virtual interviews help employers connect with job seekers when they are not in the same physical location.
Since hiring is a human process, employers would like to talk with you online (chat, video or phone) to see if you meet the requirements for the job.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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