Worker's Compensation Specialist

Scriberunner Philippines Inc.; Biñan; Presencial; PHP 725.000 - 1.060.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

HMO

Night differential

Performance incentives

Descripción de la vacante

ScribeRunner Philippines Inc. is recruiting for a NYS workers’ compensation appeals specialist. You will manage denied and underpaid NYS claims end-to-end, formulating persuasive appeals grounded in NYS MTG, and applying prior authorization rules where needed.

Role requires strong written and spoken English, familiarity with WCB and payer portals, and a high-volume outreach approach to carriers and attorneys. Training will cover MTG navigation and NYS rules. Based in Laguna, Philippines.

Formación

• Minimum 2 years in US healthcare revenue cycle (denials, appeals, AR follow-up) or related US medical-legal billing experience.
• Ability to read a denial and craft a written argument for appeal.
• Excellent written English; appeals reviewed by carriers and Board.
• Confident spoken English and comfort with high-volume outbound calls to US carriers and attorneys.
• Proficiency with claims management systems and payer portals.
• HIPAA awareness is an advantage.

Responsabilidades

• Handle NYS workers’ compensation denials from denial to resolution end-to-end.
• Read C-8.1 denials to identify the true reason for non-payment and path to overturn it.
• Draft MTG-based appeals with guideline citations.
• Apply NYS prior authorization rules as required.
• Read Notices of Decision and determine carrier vs provider stance.
• Use the WCB site to verify case status and body parts.
• Interpret carrier correspondence and reconcile with billing.
• Request Notices of Decision by email and track receipt.
• Maintain audit-ready documentation with HIPAA compliance.
• Report workload metrics: appeal volume, overturn rate, aging, patterns.
• Stay updated with NYS WCB rules and forms.

Conocimientos

US workers’ compensation

Denial interpretation

Written English

Spoken English

Outreach calls

Research & analysis

Claims systems & portals

HIPAA awareness

Herramientas

MS Office / Google Workspace

Descripción del empleo

About the role
This is not a general medical billing seat and it is not Philippine workers’ compensation. You will work on behalf of US healthcare providers — doctors, clinics and surgical practices in New York State — recovering payment for treatment they have already rendered to injured workers.

Your daily reality is the New York State Workers’ Compensation Board: its Medical Treatment Guidelines, its authorization rules, its forms, and its decisions. When a carrier denies a claim, you are the person who finds out why, builds the argument against it, and pursues it until the provider is paid.

If you like work that is technical, rule-driven and genuinely consequential — a well-built appeal is the difference between a provider being paid and writing off the care — this role will suit you.

What you’ll actually do

• Work denied and underpaid NYS workers’ compensation claims from denial through to resolution, owning each one end to end

• Read and interpret Form C-8.1 denials to identify the true reason for non-payment — not just the surface code — and determine the correct path to overturn it

• Draft and submit appeals built on the NYS Medical Treatment Guidelines (MTG), citing the specific guideline section that supports the treatment rendered

• Apply the NYS prior authorization rules — knowing which services require authorization, which are pre-authorized under the MTG, and which fall outside the guidelines entirely

• Read Workers’ Compensation Board Notices of Decision and determine clearly whether the ruling favors the carrier or the provider, then act on it

• Use the WCB website to verify case status and confirm exactly which body parts are established on a claim — the detail that decides whether a service is payable at all

• Interpret carrier correspondence, EORs and payer decisions, and reconcile them against what was billed

• Request Notices of Decision from the Workers’ Compensation Board by email, and track them to receipt

• Carry heavy outbound phone volume with insurance carriers and claimant attorneys’ offices, plus web portal follow-up — with every call documented: reference number, representative, commitment, next action

• Keep complete, audit-ready documentation on every claim, in line with US healthcare privacy standards

• Report on your own book of work: appeal volume, overturn rate, aging, and recurring denial patterns worth escalating

• Stay current as NYS Workers’ Compensation Board rules, guidelines and forms change

What we’re looking for

Strongly preferred — this is the profile we most want to hear from:

• Hands-on experience with US workers’ compensation, specifically New York State, on the provider or billing side

• Working familiarity with the NYS Medical Treatment Guidelines and using them as the basis for appeals

• Experience reading C-8.1 denials, Notices of Decision, EORs and carrier correspondence

• Experience navigating the WCB website for case and body-part verification

Required:

• Minimum 2 years in US healthcare revenue cycle — denials, appeals, AR follow-up or prior authorization. (Strong no-fault, personal injury or US medical-legal billing experience is relevant; tell us about it.)

• Demonstrated ability to read a denial and identify the real reason behind it, then build a written argument against it — we will test this at interview

• Excellent written English. Your appeals are read by carriers and by the Board; they must be clear, specific and professional

• Confident spoken English and genuine comfort with high-volume outbound calls to US carriers and attorneys’ offices — this is a phone-heavy role, not back-office only

• Strong research instinct and attention to detail; comfortable working inside portals, guidelines and regulatory documents

• Proficiency with claims management systems, payer portals and MS Office / Google Workspace

• Ability to manage a large active caseload independently, prioritize by deadline and value, and keep every claim moving

• Sound judgement with confidential medical and personal information (HIPAA awareness an advantage)

• Willingness to work US business hours

We’ll also consider you if you have solid US denials and appeals experience but no NYS workers’ comp background. We run a structured NYS ramp — MTG navigation, the authorisation matrix, C-8.1 interpretation, Notices of Decision and WCB case lookup — and we’d rather train a sharp, curious specialist than settle for a mediocre one.

What we offer

• A specialist role in a newly formed team — early members shape how it works, and grow with it

• Structured training in NYS workers’ compensation, a niche skill set few people in the Philippines hold and that raises your market value considerably

• Clear progression into senior specialist, QA and team lead roles as the department scales

• Competitive salary, full statutory benefits, HMO, and night-differential and performance incentives as applicable

• Direct access to leadership, real ownership of your work, and a culture where good reasoning is valued over volume alone

About ScribeRunner

ScribeRunner Philippines Inc. supports US healthcare providers with revenue cycle and medical administrative services. We take a partnership view of our clients: their financial health is the measure of our work. We are building our Workers’ Compensation service line now — which is why this role exists and why the right person has an unusual amount of room to grow.