Workers’ Compensation Medical Billing Specialist

This is a fully remote position, open to applicants in Florida, +2 more states.

📋 Description

• Oversee billing and accounts receivable for Pennsylvania Workers’ Compensation claims.

• Conduct regular follow-ups on outstanding, unpaid, and underpaid Workers’ Compensation claims.

• Liaise with insurance carriers, third-party administrators, adjusters, nurse case managers, and other claim representatives to address outstanding balances.

• Evaluate payments and remittance documentation for accuracy, identifying any inappropriate reductions, denials, and underpayments.

• Investigate and resolve denied or rejected bills related to claim information, authorization, compensability, documentation, coding, and billing requirements.

• Prepare and submit reconsiderations, appeals, corrected bills, and supporting documentation as needed.

• Detect discrepancies between billed charges, expected reimbursements, and actual payments received.

• Maintain precise account notes that document collection activities and follow-up actions.

• Systematically work through Workers’ Compensation aging reports and prioritize accounts needing immediate attention.

• Obtain and verify claim information, including carrier/TPA, adjuster details, claim numbers, dates of injury, and authorization data.

• Recognize recurring denial and payment trends and escalate systemic issues to management.

• Collaborate with coding, authorization, clinical, and front-end teams to resolve reimbursement challenges.

• Ensure consistent account follow-up and meet established productivity and A/R performance benchmarks.

⛳️ Requirements

• Must reside in New Jersey, Pennsylvania, or Florida.

• Prior experience in Pennsylvania Workers’ Compensation medical billing and/or accounts receivable is highly preferred.

• Proficient understanding of the Pennsylvania Workers’ Compensation billing process and fee schedule.

• Experience in communicating with Workers’ Compensation carriers, TPAs, and adjusters.

• Proven ability to research and resolve denials, reductions, underpayments, and unpaid claims.

• Capability to interpret EOBs/EORs and determine the appropriate next steps for resolution.

• Familiarity with medical billing, CPT/HCPCS, and ICD-10 terminology.

• Experience with EHR/practice management systems and electronic billing platforms.

• Exceptional attention to detail and documentation skills.

• Persistent and comfortable managing high-volume claim follow-up and collection activities.

• Ability to independently research issues and guide accounts through to resolution.

• Must hold a minimum of a high school diploma or equivalent.

• 2+ years of experience in Pennsylvania Workers’ Compensation billing or collections is preferred.

• Experience with Workers’ Compensation claims for a specialty medical practice is preferred.

• Background in neurosurgery, orthopedics, pain management, physical therapy, or other surgical/specialty care is preferred.

• Experience managing high-dollar surgical or procedural claims is preferred.

• Strong understanding of denial and underpayment trends with the ability to identify root causes is preferred.

• Excellent organizational and prioritization skills are preferred.

• Confident and professional communication skills with adjusters, carriers, TPAs, providers, and internal teams are preferred.

• Experience managing a dedicated Workers’ Compensation A/R inventory from initial billing through to final resolution is preferred.

🏝️ Benefits

• Full-time position.

• Available in-office, remote, or hybrid work arrangements.

• Equal opportunity employer.

• Diverse workplace across all levels of the organization.