Workers Comp Claims Representative

Elevate Patient Financial Solutions is seeking detail-oriented and proactive professionals to join our team as a Workers Compensation Claims Representative. This remote, full-time opportunity offers a consistent schedule of Monday through Friday, 7am - 4pm CST. If you''re passionate about making a meaningful impact and growing your career in a purpose-driven environment, this is your opportunity to shine.

In 2024, our Workers Compensation department resolved over 175,000 claims on behalf of our hospital clients and their patients.

In this role, you'll play a key part in helping hospitals and medical providers get paid for care as a result of work-related injuries. You'll gather important workers' compensation details and insurance information by working closely with hospitals, employers, patients, and other sources. You'll also handle submitting claims and documentation to insurance carriers, reviewing payments and denials, and writing appeals when needed. Throughout the process, you'll stay in touch with insurance companies, employers, attorneys, and patients to make sure everything moves smoothly and providers receive the payments they're owed.

Job 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 Elevate PFS'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
• 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

Benefits

ElevatePFS believes in making a positive impact not only within our industry but also with our employees -the organization's greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.

• Medical, Dental & Vision Insurance
• 401K (100% match for the first 3% & 50% match for the next 2%)
• 15 days of PTO
• 7 paid Holidays
• 2 Floating holidays
• 1 Elevate Day (floating holiday)
• Pet Insurance
• Employee referral bonus program
• Teamwork: We believe in teamwork and having fun together
• Career Growth: Gain great experience to promote to higher roles

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.

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, PFS is an Equal Opportunity Employer

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