01Key Responsibilities
Analyse and evaluate workers compensation claim payments using client proprietary software,systems and tools. Use payment documentation provided by payers to determine if the medical
provider has been reimbursed in compliance with the applicable state workers compensation
fee schedule and/or PPO contract.
Research, request and acquire all pertinent medical records, implant manufacturers invoices andany other supporting documentation necessary and then submit with hospital claims to insurance
companies to ensure prompt correct claims reimbursement.
Conduct timely and thorough telephone follow-up with payers to ensure claims with supportingdocumentation have been received and facilitate prompt reimbursement.
Prepare correct Workers Comp initial bill packet or appeal letter using Client systems tools andsubmit with all necessary supporting documentation to insurance companies.
Other duties as required.Required Skills:
Bachelors Degree in any discipline.Preferred Experience working for a US based BPO OR US healthcare insurance industryexperience OR a similar experience recommended.
Competent in MS Office Suite and Windows applications.Strong verbal communication skills.Fast and accurate typing skills while maintaining a conversation.Multitasking of data entry while conversing with Client contacts and insurance companies.Ability to professionally and confidently communicate to outside parties via phone, email andfax.
Ability to handle large volumes of work while maintaining attention to detail.Ability to work in a fast-paced environment.Work under limited supervision, manage multiple tasks and prioritize assignments within limitedtime constraints.
Effectively communicate issues/problems and results that impact timelines for projectcompletion.
Ability to interact professionally at multiple levels within the organization.Timely and regular attendance.Work Location: In person .
