Revecore Technologies
Purpose
Investigates and bills workers’ compensation claims and resolve troubled and/or denied workers compensation claims.
Essential Duties and Responsibilities
- Reviews provider account notes and account history. Obtains accident details, employer contact information and worker’s comp carrier/claim information. Documents information in Needles.
- Bills worker’s comp carriers. Obtains and verifies claim information, accident details, carrier billing information, and necessary billing documents from providers.
- Performs follow-up activities with employers, carriers, adjusters and patients. Verifies bill is on file; verifies required documentation was received; and obtains bill processing status.
- Resolves regular, disputed and denied accounts through communication with adjusters and patients. Reviews EOB’s, resolves medical coding issues and requests by requesting corrected UBs. Follows up with patients to obtain accident details, health insurance information and counsels patient on claims resolution upon request.
- Processes denied claims (Denials). Reviews accounts as needed and returns them clients with a detailed, written explanation for return.
- Assists department management with new employee training. Provides initial one-on-one training in position basics and best practices, and serves as a resource for new employees.
- Proactively identifies systemic client issues, such as underpayments, service line issues, etc) and reports these issues to department management.
- Performs follow-up activities with adjusters to verify receipt of appeal letters, obtain EOB’s, request bill review explanations and/or documentation, dispute charges, dispute contracts, obtain payment information, and provide supporting documentation to support appeal, applicable when working with High Dollar accounts.
- Performs special projects or tasks as assigned.
- Maintain confidential information, whether verbal, written or electronic, which I will learn in the course of my work at Revecore.
- Will not access or attempt to access confidential data that is unrelated to my job duties in the course of my work at Revecore.
- Will not disclose Protected Health Information (PHI) in violation of law.
Job Knowledge, Skills and Abilities Required
- Ability to communicate effectively verbally and in writing.
- Ability to speak on a one-to-one basis with patients, attorneys and adjusters using appropriate vocabulary and grammar to explain what is required and obtain information.
- Demonstrated ability to work independently and follow-through on assignments with minimal direction.
- Working knowledge or ability to learn state workers’ compensation laws and regulations as assigned.
- Skilled in problem resolution and processing numerous types of denials.
- Must be able to produce accurate work while maintaining attention to detail.
- Willingness to work cooperatively in a team environment.
- Must have a high level of attention to detail and be skilled in organizing and prioritizing work.
- Basic knowledge of computer operation; working knowledge of Word Perfect and Outlook; working knowledge of or ability to learn AcciClaim and SharePoint.
- Proven experience processing Workers’ Compensation claims on behalf of healthcare providers strongly preferred, but not required.
Education and Experience Requirements
- High School Diploma or equivalent.
- At least one year overall work experience, preferably in a professional office environment.
Supervisory Responsibilities None.
Working Conditions/Environment/Physical Demands/Travel Required
- General office working conditions; sitting and using a computer and a telephone for long periods of time.
- Sedentary working conditions with some standing, walking, bending, and stooping required.
- Near acuity and manual dexterity using a computer, telephone and other electronic equipment for the majority of any work day.
- Protection from weather conditions but not necessarily from temperature changes.
- Percentage of travel: negligible.