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. Documents information in MRA’s case management system, AcciClaim. Bills workers’ comp carriers. Obtains and verifies claim information, accident details, carrier billing information, and necessary billing documents from providers. Verifies bill is on file; verifies required documentation was received; and obtains bill processing status. Resolves regular, disputed and denied accounts through communication with adjusters and patients. Reviews EOBs, 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. Assists department management with new employee training. Provides initial one-on-one training in position basics and best practices, and serves as a resource for new employees. Proactively 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 EOBs, 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 or tasks as assigned.
Knowledge, Skills and Abilities required:
- Ability to communicate effectively verbally and in writing.
- 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.
- Working knowledge of state workers’ compensation laws and regulations.
- Skilled in problem resolution and processing numerous types of denials.
- Must be able to produce accurate work while maintaining attention to detail.
- Willingness to work cooperatively in a team environment.
- Must have a high level of attention to detail and be skilled in organizing and prioritizing work.
- Basic knowledge of computer operation; working knowledge of Word Perfect and Outlook; working knowledge of or ability to learn AcciClaim and SharePoint.
- High School Diploma or equivalent required.
- Minimum of one year experience billing workers’ comp claims or working with state workers’ comp fee schedules.
MRA participates in E-Verify, is an Equal Opportunity Employer and complies with all Federal and State Regulations.
MRA offers a full array of Total Rewards from traditional varieties of compensation and benefits to personal growth and recognition. Some of these benefits include medical, dental, and vision coverage, flex-scheduling around core business hours, paid time off, flexible spending account, 401k matching, achievement recognition and more!
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.