Workers’ Compensation Claims Specialist is a full-time position in our Franklin, TN Headquarters. The Workers’ Compensation Claims Specialist investigates and bills workers’ compensation claims and resolves troubled and/or denied workers compensation claims. This position obtains accident details, employer contact information and worker’s comp carrier/claim information and documents in the account notes. Follows up with patients to obtain accident details, health insurance information and counsels patient on claims resolution upon request Bills worker’s comp carriers. Obtains and verifies claim information, accident details, carrier billing information, and necessary billing documents from providers. Performs follow-up activities with employers, carriers, adjusters and patients. Verifies bill is on file and required documentation was received; obtains bill processing status. Resolves regular, disputed and denied accounts through communication with adjusters and patients. Reviews EOB’s, resolves medical coding issues and requests by requesting corrected UBs. Processes denied claims (“Denials”). Reviews accounts as needed and returns them clients with a detailed, written explanation for return. Demonstrates a proactive approach and identifies systemic client issues, such as underpayments, service line issues, etc. and reports these issues to department management. Performs follow-up activities with adjusters to verify receipt of appeal letters, obtain EOB’s, request bill review explanations and/or documentation, dispute charges, dispute contracts, obtain payment information, and provide supporting documentation to support appeal, applicable when working with High Dollar accounts.
Performs special projects as assigned.
- High School Diploma or equivalent required, some college preferred.
- At least one year overall work experience, preferably in a professional office environment.
- Basic knowledge of computer operation; working knowledge of Word Perfect and Outlook; working knowledge of or ability to learn AcciClaim and SharePoint.
- Proven experience processing Workers’ Compensation claims on behalf of healthcare providers strongly preferred, but not required. Working experience with workers’ compensation claims and regulations is preferred.
- Demonstrate ability to speak on a one-to-one basis with patients, attorneys and adjusters using appropriate vocabulary and grammar to explain what is required and obtain information.
- Demonstrated ability to work independently and follow-through on assignments with minimal direction.
MRA participates in E-Verify, is an Equal Opportunity Employer and complies with all Federal and State Regulations.
Medical Reimbursements of America (MRA) provides specialty reimbursement solutions that identify and recover additional revenue for hospitals and health systems nationwide. Our team of specialized attorneys, revenue cycle experts, and account resolution specialists has shaped the motor vehicle and work comp recovery industries, delivering results to leading health systems nationwide. Now, in addition to managing complex accident claims, our MRA Integrity™ solution provides payment integrity services that identify and recover underpayments for health claims considered to be “paid in full”, including a unique approach to recovering underpayments from traditional Medicare. Together, MRA services deliver new revenue and the assurance that hospitals capture every available revenue dollar. Based in Franklin, Tennessee, MRA continues to proudly serve as the definitive source for specialty reimbursement services for more than 500 hospitals and health systems nationwide.