The Workers’ Compensation Accounts Receivable (AR) Specialist is responsible for managing and collecting outstanding workers’ compensation claims and balances. This role focuses on timely follow-up, accurate posting of payments, denial resolution, and effective communication with payers, employers, and internal teams to ensure maximum reimbursement and compliance with workers’ compensation regulations.
Key Responsibilities
- Manage full-cycle accounts receivable for workers’ compensation claims
- Submit, review, and follow up on workers’ compensation claims to ensure timely payment
- Investigate and resolve claim denials, underpayments, and payment delays
- Post payments, adjustments, and contractual allowances accurately
- Communicate with insurance carriers, third-party administrators (TPAs), employers, and case managers regarding claim status
- Review Explanation of Benefits (EOBs) and Explanation of Review (EORs) for accuracy
- Appeal denied or reduced claims according to state workers’ compensation guidelines. This may include filing 104B forms and attending virtual mediation hearings.
- Supply attorneys with cost containment spreadsheet breakdowns
- Maintain accurate documentation and notes within billing and practice management systems
- Monitor aging reports and prioritize high-dollar or aged accounts
- Ensure compliance with state-specific workers’ compensation billing rules and cost containment rates
- Collaborate with billing, coding, and clinical teams to resolve claim discrepancies
- Provide reporting and status updates to management as requested
Required Qualifications
- High school diploma or equivalent (Associate’s degree preferred)
- 2+ years of experience in medical billing and accounts receivable, with a strong focus on workers’ compensation
- In-depth knowledge of workers’ compensation billing processes, cost containment rates, and regulations
- Experience working with insurance carriers, TPAs, and employer-based claims
- Proficiency with medical billing software and Microsoft Office (Excel, Word, Outlook)
- Strong analytical, organizational, and problem-solving skills
- Excellent verbal and written communication skills
- Ability to manage multiple accounts and meet deadlines in a fast-paced environment
Preferred Qualifications
- Experience with appeals and litigation-related workers’ compensation claims
- Familiarity with state-specific workers’ compensation systems and portals
Skills & Competencies
- Attention to detail and accuracy
- Persistence and strong follow-up skills
- Ability to interpret EOBs/EORs and fee schedules
- Time management and prioritization
- Professional and customer-service-oriented communication
Work Environment
- Hybrid: In office/remote
- Full-time position, standard business hours M-F.
- 8hr shift/no weekends
- Healthcare setting: Ambulatory surgery center, outpatient, and private practice
Medical Specialties:
- Orthopedics
- Pain Medicine
- Podiatry
- Chiropractic
- Physical Therapy
- Spine
- Sports Medicine
Pay: $18.00 - $25.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Tuition reimbursement
- Vision insurance
Work Location: In person
