We are seeking experienced Billing Specialists with expertise in medical claims processing, medical documentation interpretation, and compliance with billing regulations related to workers’ compensation cases. The ideal candidate will have a strong understanding of medical billing standards, prior authorization processes, and New York State Workers’ Compensation regulations.

Responsibilities:

Review and make recommendations on workers’ compensation medical claims for accuracy, compliance, and completeness.

Analyze medical documentation to ensure proper coding and adherence to billing regulations.

Assess compliance with New York State Workers’ Compensation billing guidelines and medical treatment guidelines (MTGs).

Identify and resolve discrepancies, denials, or disputed claims efficiently.

Work collaboratively with the team to ensure timely deliverables.

Maintain up-to-date knowledge of workers’ compensation laws, medical billing codes, and regulatory changes.

Qualifications:

Minimum 3 years of experience in medical billing, coding, or claims processing, with a focus on workers’ compensation.

Strong understanding of medical terminology, CPT, ICD-10, and HCPCS coding systems.

Experience interpreting medical treatment guidelines (MTGs) and drug formularies.

Knowledge of prior authorization processes and regulatory compliance for workers' compensation cases.

Proficiency and understanding of fee schedules, electronic billing systems, and medical claims processing platforms.

Excellent analytical, communication, and problem-solving skills.

Ability to work independently and meet deadlines in a remote setting.

Preferred:

Certification in Medical Billing and Coding (CPC, CPB, or equivalent).

Experience with OnBoard Limited Release (OBLR) or similar prior authorization systems.

Familiarity with New York State Workers’ Compensation Board regulations.