Biller

Scheduled Weekly Hours: 40

• The Worker''s Compensation & Motor Vehicle Accident (WC/MVA) Coordinator is responsible for coordinating and managing workers'' compensation and motor vehicle accident claims throughout a patient''s course of treatment. This role serves as a liaison between patients, providers, insurance carriers, attorneys, nurse case managers, and internal departments to ensure appropriate authorization, coordination of care, and reimbursement for services.

A key responsibility of this position is negotiating reimbursement rates and securing authorization approvals with Workers'' Compensation carriers for initial provider consultations, surgical procedures, and other medically necessary services. The Coordinator works to obtain reimbursement rates above state-mandated fee schedules when appropriate, helping to maximize revenue while ensuring patients receive timely access to care.

The Coordinator facilitates claim setup, authorization management, reimbursement negotiations, scheduling, and documentation processing while supporting efficient patient care, regulatory compliance, and financial stewardship for the organization.

Education/Training

• High School diploma or equivalent

Licenses/Certification: N/A

Required Qualifications and Skills:

• Minimum of 1-2 years of medical billing, medical office, or healthcare administrative experience.
• Experience working with Workers' Compensation and/or Motor Vehicle Accident claims.
• Knowledge of Personal Injury Protection (PIP) exhaustion requirements and coordination of benefits.
• Understanding of CPT, ICD-10, and HCPCS coding.
• Ability to review and interpret medical documentation.
• Strong organizational and time management skills.
• Excellent verbal and written communication skills.
• Ability to prioritize multiple tasks in a fast-paced environment.
• Strong analytical, problem-solving, and customer service skills.
• Proficiency with electronic medical records and healthcare software applications.

Preferred Qualifications and Skills:

• Previous experience negotiating reimbursement rates, surgical authorizations, and initial consultation fees with Workers' Compensation insurance carriers and adjusters.
• Demonstrated knowledge of Workers' Compensation fee schedules, DIA reimbursement guidelines, and payer contract negotiations.
• Ability to effectively advocate for appropriate reimbursement while maintaining positive working relationships with insurance carriers and case managers.
• Experience in orthopedic or specialty medical practice.
• Familiarity with medical terminology, anatomy, and physiology.
• Experience obtaining prior authorizations and insurance verification.

Essential Job Functions:

• Establish and maintain Workers' Compensation (WC) and Motor Vehicle Accident (MVA) cases within the electronic medical record system.
• Obtain and verify claim information with insurance carriers, adjusters, attorneys, and nurse case managers.
• Negotiate reimbursement rates with Workers' Compensation carriers and adjusters for initial provider consultations, surgical procedures, and other authorized services to maximize reimbursement and ensure appropriate compensation for services rendered.
• Secure and document written approval for negotiated reimbursement rates, treatment plans, surgeries, and other medically necessary services prior to scheduling.
• Coordinate authorizations and approvals for office visits, evaluations, diagnostic testing, surgeries, physical therapy, occupational therapy, second opinions, and other medically necessary services.
• Monitor negotiated agreements and authorization approvals to ensure reimbursement terms are accurately documented, communicated, and billed.
• Serve as the primary liaison between providers, insurance carriers, adjusters, attorneys, nurse case managers, patients, and internal departments regarding authorizations, reimbursement negotiations, treatment approvals, and claim-related issues.
• Communicate with insurance carriers and adjusters regarding coverage determinations, treatment authorizations, reimbursement approvals, and claim status updates.
• Process and manage incoming and outgoing communications related to WC/MVA claims.
• Assist with scheduling urgent and high-priority patients referred from Occupational Health Services, Emergency Departments, and outside facilities.
• Review and respond to requests from attorneys, insurance representatives, and nurse case managers regarding treatment status, medical records, and care updates.
• Manage appointment changes and coordination requests from nurse case managers and insurance carriers.
• Collaborate with providers, leadership, and the Central Billing Office (CBO) to resolve authorization, reimbursement, and claim-related issues and optimize financial outcomes.
• Work closely with Patient Financial Services, hospital departments, and outside organizations to ensure accurate claim processing and payment resolution.
• Maintain accurate, complete, and timely documentation in accordance with organizational policies, payer requirements, and regulatory standards.
• Perform other duties as assigned.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Age and Diversity Related Criteria:

Consistently treats patients, colleagues, and visitors with dignity and respect, while being sensitive to the differing needs of all age groups, backgrounds, characteristics, and cultures.

Ability to Fulfill Job Expectations:

Must have the ability to perform the essential functions of the position, including required work hours, locations, and physical demands, without posing a direct threat to the health and safety of themselves or other individuals in the workplace, and with or without reasonable accommodation.

Physical Demands:

• Frequently sits for extended periods while performing administrative, scheduling, authorization, and computer-based work.
• Frequently uses a computer, keyboard, telephone, and other standard office equipment.
• Frequently communicates with patients, providers, insurance carriers, attorneys, nurse case managers, and staff in person, by telephone, and electronically.
• Occasionally stands, walks, bends, reaches, stoops, and moves throughout the office and clinical environment.
• Occasionally lifts, carries, pushes, or pulls items weighing up to 15 pounds, such as files, records, and office supplies.
• Requires visual acuity to review medical records, insurance documentation, claims information, and electronic health record data.
• Requires the ability to concentrate and manage multiple priorities in a fast-paced healthcare environment.
• Requires the ability to perform repetitive hand and finger movements associated with typing, data entry, and document management.
• Salary Range: $21.06-$31.96
• Salary Range Details

The pay range displayed on each job posting reflects the anticipated range for new hires. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set, and education. This is not inclusive of the value Sturdy Health's benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement. For annual salaries this is based on full-time employment.

• Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.