Job Details
- Type of Work:
Full-time
- Work Setup:
Hybrid
- Schedule:
40 hrs/week
Job Description
Scale-Up Philippines is seeking a detail-oriented and experienced Workers Compensation AR Specialist on behalf of one of our healthcare clients. The ideal candidate will be responsible for managing billing processes related to workers’ compensation claims, ensuring accurate submissions, timely follow-ups, and efficient reimbursement handling.
Key Responsibilities:
- Review and respond to all pending emails in the Workers’ Compensation email inbox.
- Send daily files to Carisk (Monday–Thursday only).
- Upload AES files (biweekly, if scheduled).
- Clear dirty claims from Carisk
- File Workers’ Compensation appeals.
- Follow up on appeals over 45 days old.
- Submit manual claims through the USDL website.
- Process medical record and statement requests.
- Enter encounter/payment notes for all payment EOBs processed.
- Enter encounter notes for all Workers’ Compensation appeals filed.
- Complete temporary duty of entering zero-pay encounters.
- Complete miscellaneous tasks assigned by management.
Qualifications:
- High school diploma or equivalent required; an Associate’s or Bachelor’s degree in Healthcare Administration, Medical Billing and Coding, Health Information Management, or a related field is preferred.
- Minimum of 1–2 years of experience in Workers’ Compensation, medical billing, claims processing, revenue cycle management (RCM), or healthcare administration.
- Experience managing Workers’ Compensation appeals, claim follow-ups, payment posting, and insurance correspondence.
- Knowledge of claims follow-up, appeal filing, EOB documentation, medical record requests, and payment posting support.
- Working knowledge of Explanation of Benefits (EOBs), medical documentation, and insurance reimbursement processes.
- Familiarity with Carisk, USDL, AES file uploads, or similar Workers’ Compensation platforms is highly preferred.
- Proficiency in Microsoft Office Suite, including Outlook, Excel, and Word.
- Experience using electronic medical record (EMR) or practice management systems.
- Strong attention to detail when entering encounter notes, payment notes, appeal documentation, and zero-pay encounters.
- Ability to review, manage, and respond to email inquiries professionally and accurately.
- Comfortable submitting manual claims through healthcare portals or online systems.
- Highly organized and able to manage daily, biweekly, and time-sensitive tasks.
- Ability to prioritize multiple tasks while meeting deadlines in a fast-paced healthcare environment.
- Excellent written and verbal communication skills with a strong customer service mindset.
- Proactive, reliable, and able to work independently while maintaining accuracy and confidentiality in accordance with HIPAA guidelines.
- Able to follow established workflows and complete miscellaneous tasks assigned by management.
Preferred Qualifications
- Experience working with U.S. Workers’ Compensation insurance carriers, claims management, and appeals processes.
- Familiarity with Carisk, the USDL portal, or similar Workers’ Compensation and case management platforms.
- Knowledge of CPT, ICD-10, HCPCS, medical terminology, and healthcare billing procedures.
- Experience processing medical record requests, insurance documentation, and claim reconciliation.
- Ability to identify, investigate, and resolve denied, unpaid, or delayed claims.
- Strong analytical and problem-solving skills with the ability to recommend process improvements.
- Comfortable handling high-volume administrative tasks while maintaining a high level of accuracy.
- Demonstrates professionalism, accountability, adaptability, and a collaborative team-oriented approach.
- Familiarity with orthopedic, rehabilitation, pain management, or musculoskeletal healthcare settings is an advantage, as these are core service areas of the company.
Why Join Scale Up Philippines?
At Scale Up Philippines, we connect talented Filipino professionals with world-class clients who value people as much as results. This one is for someone ready to grow.
If you’re passionate about this position and ready to grow your career with a global team, we’d love to hear from you!
