Medical Billing & Collections Specialist – Workers' Compensation & No-Fault (NF)
Full-Time IN person
Salary Range: $ $24.00 - $30.00/hour
Job Summary
We are seeking an experienced, detail-oriented Medical Billing and Collections Specialist with highly specialized expertise in Workers' Compensation and No-Fault (NF) claims processing. In this role, you will manage the full revenue cycle for our specialty cases, ensuring complete compliance with state regulatory boards, minimizing claim denials, and aggressively pursuing outstanding accounts receivable. The ideal candidate has deep familiarity with complex legal documentation, medical treatment guidelines, and the strict timelines required to secure timely reimbursements.
Key Responsibilities
• Claims Submission: Prepare, review, and electronically submit or mail high-volume Workers' Compensation and No-Fault medical claims with all required supporting documentation (e.g., medical reports, proof of mailing).
• Documentation & Compliance: Ensure all state-specific mandatory forms (such as New York's WC Board MTG forms, C-4 variants, or NF-3 verification forms) are meticulously filled out and aligned with documented treatments.
• Accounts Receivable & Follow-up: Monitor aging AR reports specifically targeting aging WC and NF accounts. Proactively follow up with insurance adjusters, case managers, and legal representatives regarding delayed or disputed claims.
• Denial Management & Appeals: Review, audit, and systematically appeal denied, short-paid, or unpaid claims. Prepare robust arbitration packages or medical necessity arguments to overturn adverse decisions.
• Verification of Benefits: Verify case details, including established body parts, carrier case numbers, dates of injury, policy limits, and coordination of benefits to prevent upfront coverage gaps.
• Communication: Act as the primary liaison between the clinic, insurance carriers, patient attorneys, and employers to resolve outstanding billing inquiries efficiently.
Required Qualifications & Skills
• Experience: Minimum of [2-3] years of dedicated experience handling Workers' Compensation and No-Fault medical billing and collections within a medical practice or billing agency.
• Technical Knowledge: Comprehensive understanding of CPT, ICD-10 coding, modifiers, and state-specific workers' comp fee schedules.
• System Proficiency: Hands-on experience with EMR/EHR billing platforms (e.g., Epic, eClinicalWorks, Athenahealth) and insurance web portals.
• Skills: Exceptional attention to administrative detail, strong negotiation/collections skills, and the capability to interpret complex legal and medical correspondence.
• Education: High School Diploma or equivalent required; Medical Billing and Coding Certification (e.g., CBCS, CPC) is highly preferred.
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