Senior WC Claims & Appeals Specialist

Innovative Medical Management, LLC; Nashville (TN); Remote; USD 70,000 - 100,000; Full time

Job summary

Innovative Medical Management, LLC in Nashville, TN, seeks a Senior Workers' Compensation Specialist, Complex Claims. The role autonomously manages WC and No-Fault accounts, verifies carrier details, and handles billing, denials, and appeals to resolution.

You will mentor staff, track patterns in denials, and work with leadership to streamline workflows, SOPs, and reimbursement processes, ensuring timely payments and accurate record-keeping.

Responsibilities

• Verifies workers' compensation carrier and claim information before and during billing.
• Confirms correct WC carrier, claim number, date of injury, employer and adjuster contact details.
• Obtains and documents authorizations and referrals for scheduled services.
• Uses carrier portals, adjusters, employer contacts and web portals, noting findings in the patient account.
• Initiates contact with WC insurance carriers, adjusters and portals on outstanding bills and updates accounts.
• Prepares and submits claims, verifying accuracy and correcting errors before submission.
• Prepares appeals with all required documentation and submits them to the carrier within filing deadlines.
• Corrects inaccurate demographic and insurance information for billing.
• Alerts the team to trends, recurring denials or billing issues as they arise.
• Works with leadership to streamline workflows and improve reimbursement and collection outcomes, including maintaining SOPs.
• Mentors and trains less-experienced team members and serves as the go-to expert on workers' compensation pricing.

Job description

Innovative Medical Management, LLC in Nashville, TN, seeks a Senior Workers' Compensation Specialist, Complex Claims. The role autonomously manages WC and No-Fault accounts, verifies carrier details, and handles billing, denials, and appeals to resolution.

You will mentor staff, track patterns in denials, and work with leadership to streamline workflows, SOPs, and reimbursement processes, ensuring timely payments and accurate record-keeping.