Remote Workers' Compensation Claims Specialist

Paycom; Houston (TX); Hybrid; USD 26,000 - 32,000; Full time

Job summary

Paycom operates a remote WC billing role based in Houston, TX, handling verification of injury/claims for workers' compensation patients and auditing billing records. You will be the primary contact for adjustors and case managers, coordinating with physicians and clinics on authorization and billing.

The position requires a High School Diploma and about three years of WC billing in a medical office, plus knowledge of ODG treatment, RTW and DWC fee guidelines.

Qualifications

• High School Diploma required.
• Three years medical office WC billing experience.
• Knowledge of Texas Workers’ Comp ODG treatment, RTW and fee guidelines.
• Excellent computer knowledge and communication skills.
• Ability to sit for long periods and work remotely.

Responsibilities

• Call adjustors to verify WC injuries/claims.
• Audit WC appointments for comments/authorization/DWC.
• Prepare claims and documentation for filing.
• Act as point of contact for adjustors and case managers.
• Explain ODG to physicians and support RTW processes.
• Prepare DWC 73’s & 69’s.
• Authorize WC procedures.
• Follow up on unpaid claims and appeals.
• Advise physicians on dispute cases incl. Benefit Review Conferences.
• Stay updated on DWC rules (ODG, RTW, preauthorization, fee guidelines).
• AR follow up to ensure timely payments.
• All other duties as assigned.

Skills

Computer skills

Communication

Attention to detail

Problem solving

Education

High School Diploma

Job description

Paycom operates a remote WC billing role based in Houston, TX, handling verification of injury/claims for workers' compensation patients and auditing billing records. You will be the primary contact for adjustors and case managers, coordinating with physicians and clinics on authorization and billing.

The position requires a High School Diploma and about three years of WC billing in a medical office, plus knowledge of ODG treatment, RTW and DWC fee guidelines.