Worker Compensation Specialist | Permanent WFH

We are seeking an experienced Workers' Compensation Billing Specialist to join our Revenue Cycle Management team. The ideal candidate will have extensive experience managing the full lifecycle of Workers' Compensation claims and be proficient in ModMed (Modernizing Medicine) Practice Management/EMR.

This role requires expertise in Workers' Compensation billing, insurance follow-up, adjuster communications, disability claim processing, and responding to payer and medical record requests. The successful candidate will have a strong understanding of Workers' Compensation regulations, exceptional organizational skills, and a commitment to maximizing reimbursement while maintaining compliance.

Key Responsibilities

• Submit, monitor, and manage Workers' Compensation claims from submission through final payment.
• Process and maintain claim information, including employers, insurance carriers, third-party administrators (TPAs), claim numbers, adjusters, and authorizations.
• Utilize ModMed (Modernizing Medicine) daily to document account activity, update claim information, and manage billing workflows.
• Communicate with insurance adjusters, nurse case managers, employers, and attorneys regarding claim status and reimbursement.
• Respond promptly to requests for billing documentation, medical records, and claim-related information.
• Process disability claim forms and supporting documentation accurately and within required timeframes.
• Coordinate facility medical record requests while ensuring HIPAA compliance.
• Investigate and resolve denied, rejected, or underpaid Workers' Compensation claims.
• Prepare and submit appeals and reconsideration requests with appropriate supporting documentation.
• Review fee schedules, payer guidelines, and billing requirements to ensure accurate claim submission.
• Monitor aging reports and proactively follow up on outstanding balances.
• Collaborate with providers, coding staff, authorization teams, and front office personnel to resolve billing issues.
• Maintain compliance with Workers' Compensation regulations, payer requirements, and internal policies.
• Meet established productivity, accuracy, and quality standards.
  
  

Qualifications

• Minimum of 2 years of Workers' Compensation medical billing experience
• Required experience using ModMed (Modernizing Medicine) Practice Management/EMR
• Strong knowledge of Workers' Compensation billing processes, regulations, and insurance follow-up
• Experience communicating directly with insurance adjusters, third-party administrators (TPAs), and case managers
• Working knowledge of Labor & Industries (L&I) and disability claims
• Experience processing disability paperwork and responding to claim-related documentation requests
• Experience coordinating and fulfilling medical record requests
• Understanding of CPT, ICD-10, HCPCS coding fundamentals, medical terminology, and payer guidelines
• Experience with denials management, appeals, payment posting, and accounts receivable follow-up
• Excellent written and verbal communication skills
• Strong organizational skills with exceptional attention to detail
• Ability to manage multiple priorities in a fast-paced environment while working independently
• Orthopedic, pain management, spine, or multispecialty practice experience
• Experience working with multiple state Workers' Compensation programs
• Knowledge of Medicare Secondary Payer (MSP) guidelines
• CPC, CMRS, or other medical billing certification
  
  

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary
  
  

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Who are we?

BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.