Worker's Compensation Financial Counselor (Accounts Receivable)
POSITION: AR WORK COMP FINANCIAL COUNSELOR
RESPONSIBLE TO: AR Manager
JOB SUMMARY: Responsible for collecting outstanding worker compensation insurance balances from various payers. Following up with workers compensation insurance balances; analyzing denial trends and coding edits. Understand complex medical workers compensation insurance plan terminology and appeal denied claims.
- High school diploma required
- Advanced Degree or Certification preferred
- Strong accounting computer skills required
- Knowledge of ICD-10 and CPT Codes preferred
QUALIFICATIONS AND EXPERIENCE:
- Two years’ experience in accounting, data entry or medical payment posting.
- Must be proficient in Excel and creating word documents.
- Must be detail oriented.
- Ability to perform multiple and diverse tasks simultaneously.
- Strong written and verbal communication skills.
- Ability to perform multiple and diverse tasks simultaneously
- Strong written and verbal communication skills and cheerful attitude
Responsibilities include, but are not limited to, the following:
Work Comp Financial Counselor duties
- Understand how to interpret authorization and coverage for a procedure using WC manual.
- Analyze and work outstanding AR WC report and Practice Management Queues.
- Identify claim missing documents and forward to the clearing house.
- Prepare chart for settlement notices and notify all appropriate departments.
- Research appointment errors related to WC.
- Identify, research, and submit appeals as appropriate for low pay, no pay, and denials to ensure appropriate payment.
- Identify inappropriate payment or denial trends and notify the AR Manager.
- Update and repost any updated WC charge information.
- Research EHR messages from DME and Charge entry and update accounts accordingly.
- Review the clearing house upfront Edits and Rejections on a daily basis.
- Update MMI status and notify all appropriate departments.
- Review any refund request from UHS or WC carrier.
- Analyze and work scrubbers prior to spooling claims.
- Coordinate all WC correspondence and clinical paperwork using approved forms for appeals.
- Complete special projects related to WC claims as designated by the AR Manager.
General Patient Care
- Reviews all WC correspondence to ensure proper attachment have been attached to ensure chart is properly built with correct insurance information.
- Responsible for all incoming WC telephone calls; ensures action taken is document appropriately in the patient chart.
- Responsible for all incoming inquiries, both written and verbal, from nurse case managers and health insurance carriers.
- Processes WC correspondence related to billing inquire. For (i.e.: PSA forms, IME forms, contributing cause letters, etc.).
- Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice.
- Maintains detailed knowledge of practice management, electronic health record and other computer software as it relates to job functions.
- Attends continuing education courses as requested.
- Completes all other duties as assigned by the AR Manager.
- Work hours coincide with Orlando Orthopaedic Center’s operating hours (8am to 5pm)
This job has no supervisory responsibilities.
Typical Physical Demands
Work may require sitting for long periods of time, and also stooping, bending and stretching for files and supplies. Position requires manual dexterity sufficient to operate a keyboard, operate a computer, telephone, calculator, copier, and such other office equipment as necessary. Position also requires viewing computer screens and typing for long periods of time, and working in an environment which may be stressful. Position could require occasional travel.
Typical Working Conditions
Normal office environment