Workers' Compensation Specialist (2489)

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

Job Details: Level: Experienced, Job Location: Remote Worker - Houston, TX 77030, Position Type: Full Time, Education Level: High School/GED, Salary Range: $19.00 - $23.00, Job Category: Health Care,

General Job Description

Handles verification of injury/claim of all WC patients including auditing medical record for billing accuracy. Responsible for marketing to employers/WC clinics and is the point of contact for adjustors and case managers.

ESSENTIAL FUNCTIONS

• Call adjustors to verify all new and established WC injuries/claims per protocol
• Audit WC appointments for comments/authorization/DWC
• Prepare claims and documentation for filing
• Point of contact for all adjustors and case managers
• Facilitate physician’s use and understanding of ODG
• Prepare DWC 73’s & 69’s
• Authorization of all WC procedures
• Timely Follow up on appeals for unpaid claims utilizing claims maintenance
• Advise physicians on dispute cases including initiating Benefit Review Conferences
• Remain up to date on DWC rules – including ODG treatment, RTW, Preauthorization and fee guidelines
• AR Follow up to ensure claims are paid timely.
• All other duties as assigned.

QUALIFICATIONS

Education

• High School Diploma

Experience

• Three years medical office WC billing experience
• Knowledge of Texas Workers’ Comp ODG treatment, RTW and fee guidelines

Special Skills

• Excellent computer knowledge and skills
• Ability to effectively communicate both orally and written
• Adequate visual acuity to read written materials
• Ability to sit for long periods of time
• Problem solving skills
• Attention to detail

PHYSICAL DEMANDS

• Telephone – with or without headset – constantly
• Computer – constantly

ENVIORNMENTAL WORKING CONDITIONS

• Remote in your home with potential request to be in office on occasion.
• Continuously handle multiple tasks simultaneously and work as part of a team.
• Occasionally perform tedious and exacting work in frustrating conditions.