Billing Specialist- Workers' Compensation & Commercial Follow

Job Description

Job Description

Job Summary

We are seeking a detail-oriented and proactive Billing Specialist specializing in Workers' Compensation and Commercial Follow-Up to join our dynamic healthcare billing team.

This ideal candidate will have at least 2 years of medical billing/AR follow-up experience and be comfortable researching unpaid and denied claims, communicating with insurance carriers, and working outstanding accounts through resolution. Orthopedic billing experience is strongly preferred.

Responsibilities

• Follow up on outstanding Workers' Compensation and commercial insurance claims
• Work AR aging reports to resolve unpaid, underpaid, rejected, and denial claims
• Contact insurance carriers and utilize payer portal to obtain claim status and resolve outstanding balances
• Research and correct claim issues, including denials, rejections, coding/modifier issues, authorization problems, and timely filing
• Correct and resubmit claims when necessary
• Review EOBs and ERAs to identify denials, underpayments, and payment discrepancies
• Prepare and submit appeals and supporting documentation as needed
• Obtain and verify Workers' compensation claim information, including carrier, claim number, date of injury, and authorization information
• Identify recurring payer issues and escalate concerns to management
• Work assigned accounts consistently through final resolution

Qualifications:

• Minimum of 2 years of medical billing/AR follow-up experience
• Experience with commercial insurance follow-up required
• Workers' Compensation billing/follow-up experience required
• Orthopedic billing experience preferred
• knowledge of CPT, ICD-10, modifiers, EOBs, ERAs, and insurance billing guidelines
• Strong understanding of denials, appeals, and accounts receivable
• Ability to manage a high-volume workload and meet productivity expectations
• Strong communication and problem-solving skills
• Ability to work independently and as part of a billing team

We are looking for someone who is persistent, organized, and results-driven and understands that successful follow-up means taking the necessary steps to move outstanding claims toward payment and resolution.