Worker's Compensation Denial Specialist

Premier Medical Resources is seeking to hire a Workers Compensation Denial Specialist is responsible for performing insurance appeals of denied and underpaid
accounts.

This would include reviewing payer websites and performing phone calls for appealed, denied or underpaid claims
to secure payment for services rendered by the provider.

ESSENTIAL FUNCTIONS:
• Responsible for managing, monitoring, and collecting payments on accounts from all WC Third-Party Payers
• Reporting of denial trends and payer policy updates to management.
• Work with Supervisor/Manager to identify denial/payment trends and create solutions to decrease future denials
• Maintain understanding of payer contracts, claims filing deadlines and fee schedules
• Works with WC insurance providers to resolve and appeal any denied or underpaid claims.
• Assist in creation of standard appeal templates
• Performs ongoing trend analysis on third party payer payment levels to ensure that reimbursement is in accordance
with allowable amounts stated in agreements and contracts. Works with appropriate individuals to resolve
discrepancies
• Attend and participate in scheduled meetings.
• Review and resolve payment variances for assigned insurance plans.
• Perform adjustment and/or contractual write-offs when deemed appropriate
• Responds to insurance company correspondence including requests for information and claim review
• Researches and processes all refund requests within the insurance contractual obligations and state and federal
laws
• Answers billing office phone calls when needed
• Performs other related duties as assigned to support the organization

KNOWLEDGE, SKILLS, AND ABILITIES:
• Demonstrates critical thinking skills, ability to organize and respond to urgent or emergent situations.
• Demonstrates decision-making skills based on accurate information and/or analysis of data.
• Strong Communication skills.
• Knowledgeable in all medical Commercial and Government insurance plans
• Knowledge of medical terminology, CPT codes, ICD-10 codes and procedures, technical job knowledge, and
Third-Party payer requirements and reimbursement rules.
• Problem solving skills.
• Patience and ability to manage stress.
• Excellent typing and 10-key speed and accuracy.
• Proficient use of Microsoft Office programs including World, Outlook, and strong Excel skills.

EDUCATION AND EXPERIENCE:
• High School Diploma or GED
• Three (3) years of Insurance Collections/billing Reimbursement experience in a physician and/or hospital setting
• One (1) year experience with Workers Compensation