Work Comp Collections Specialist

Job Summary:

The Work Comp Collections Specialist is a nonexempt position responsible for the accurate and timely resolution of all Workers’ Comp cases. Employee will work with third party systems including workman’s compensation and commercial insurance. Employee will demonstrate awareness of sensitivity as well as competence in dealing with cultural and socioeconomic diversity of client population. This position requires strong problem-solving and analytical skills.

Performance Requirements:


  1. Knowledge of HIPAA regulations.
  2. Knowledge of and experience in work comp and private health insurance processes pertaining to claiming and coding health services.
  3. Current knowledge of ICD-10-CM & CPT-5 diagnostic coding classification systems.


  1. Skill to communicate effectively and professionally with customers and external contacts to the organization.
  2. Possess the skills to manage mild to moderate stress.


  1. Ability to read and interpret an EOB.
  2. Demonstrated P.C.  skills, i.e. proficient with MS Office products including Word, Excel, and Outlook.
  3. Excellent organizational, planning and prioritization skills.
  4. Demonstrated ability to handle multiple tasks simultaneously.
  5. Ability to meet designated deadlines is also a critical qualification.

Major Duties and Accountabilities:

  1. Responsible for ensuring appropriate insurance verification.
  2. Responsible for obtaining new patient referrals for appointments.
  3. Function as a liaison between staff, Physicians and patients regarding Worker’s Compensation protocol for patient care.
  4. Assists patients with disability forms
  5. Research and resolution of claims based on Work List assignment, the process of which could include:
  6. Contacting payers via phone or website, contacting practices, navigating cross-departmentally, writing appeals and facilitating their direction to
  7. Athena CBO for submission, and all other activities that lead to the successful adjudication of eligible workers comp claims.
  8. Document action taken as necessary
  9. Continually strive to promote and maintain exceptional internal and external customer service.
  10. Adhere to Government Regulations, Insurance Contracts and legal matters pertaining to collections, lawsuits, third party liability, probate, etc., to maximize reimbursement.
  11. Monitor payer websites for medical policy or benefits changes. Communicate changes to Management and related staff.
  12. Provide suggestions to improve daily collections workflow and inefficiencies.
  13. Demonstrate working knowledge of ICD-10, CPT and HCPCS codes and HIPAA laws.
  14. Comply with all written and stated company policies and procedures.
  15. Provide support to other department team members as necessary.
  16. Other duties as assigned.

Position Competencies:

  1. Role model for organization’s core values
  2. Customer Service: Demonstrates the highest standards for friendly, courteous and caring interaction with patients, physicians, customers, and fellow employees.
  3. Professional presence
  4. Communication Demonstrates ability to accept and understand instructions, expresses self clearly and concisely.
  5. Adaptability/Flexibility Demonstrates the ability to cope with pressure, grasp new ideas and methods, and adjust responses to meet the changing work environment.
  6. Independence/initiative Demonstrates reliability, followthrough, ability to work with minimum supervision, and desire and ability to accept additional responsibility.
  7. Confidentiality
  8. Emotional Intelligence Maintain basic emotional and social competencies to include self-awareness, self-regulation, motivation, empathy, and social skills.

Job Qualifications:

Equipment operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, calculators, etc.

Education/Experience:  Job will require a minimum of an AA degree along with general knowledge of Medical Coding (ICD-9/10). Employee should have at least five years current experience and working knowledge of EMR systems and coding (ICD-9/10) and billing functions of third party payer systems.

Physical: Position is in a well-lighted office environment and involves sitting approximately 90 percent of the day, walking or standing the remainder.