Workers' Compensation Specialist-Remote TX Resident Req

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.