Employer: Revecore Technologies
Position Summary
Investigates and bills workers’ compensation claims and resolve troubled and/or denied claims.
Duties and Responsibilities
- Review provider account notes and account history. Obtains accident details, employer contact information and worker’s comp carrier/claim information. Document information in Needles.
- Bill worker’s comp carriers. Obtain and verify claim information, accident details, carrier billing information, and necessary billing documents from providers.
- Perform follow-up activities with employers, carriers, adjusters and patients. Verify bill is on file; verifies required documentation was received; and obtains bill processing status.
- Resolve regular, disputed and denied accounts through communication with adjusters and patients. Review EOB’s resolves medical coding issues and requests by requesting corrected UBs. Follow up with patients to obtain accident details, health insurance information and counsels patient on claims resolution upon request.
- Process denied claims (“Denials”). Review accounts as needed and returns them clients with a detailed, written explanation for return.
- Assist department management with new employee training. Provide initial one-on-one training in position basics and best practices and serves as a resource for new employees.
- Proactively identify systemic client issues, such as underpayments, service line issues, etc) and report these issues to department management.
- Perform 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.
- Perform special projects or tasks as assigned.
- Maintain confidential information, whether verbal, written or electronic, which I will learn in the course of my work.
- Will not access or attempt to access confidential data that is unrelated to my job duties in the course of my work.
- Will not disclose Protected Health Information (PHI) in violation of law.
Skills and Experience
- High School Diploma or equivalent.
- At least one year overall work experience, preferably in a professional office environment.
- 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.