Worker's Compensation Auditor

October 11

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Titan Health Management Solutions

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Medical Reimbursement Audits (incl Zero Balance) • Medical Insurance Collections • Clinical Denials and Recovery • Revenue Cycle Management • Zero Balance Audit

51 - 200

Description

• Conduct thorough audits of zero-balance accounts, verifying that all claims, settlements, and transactions are accurately documented and comply with legal and financial standards. • Review and interpret legal documents such as settlements, contracts, and claim agreements to ensure compliance with state and federal regulations. • Assist in identifying trends, risks, and improvement opportunities within the workers' compensation claim process. • Maintain up-to-date knowledge of workers' compensation laws, rules, and regulatory changes that may affect claim handling and auditing practices. • Detect and verify underpayments by Worker Compensation plans, ensuring accurate financial reconciliation for our hospital. • Develop compelling appeal and grievance arguments, including precise calculations of short payments. • Draft and submit appeal letters or reconsideration requests via various channels (phone, fax, email, or payor portal). • Assist in the collection of appeals by effectively communicating with claims adjusters and worker compensation plans to expedite accurate payments when needed.

Requirements

• Associate's or Bachelor's degree in Paralegal Studies or a related field. • Certification as a paralegal (e.g., from the National Association of Legal Assistants) preferred. • Minimum of 2 years of experience in workers' compensation claims auditing, insurance auditing, or related fields. • Strong knowledge of workers' compensation laws, regulations, and industry best practices, specifically in states that do not have a worker’s compensation fee schedule. • Strong experience working with facility and ASC claims. • High attention to detail and the ability to identify discrepancies in financial documentation. • Excellent analytical, organizational, and problem-solving skills. • Ability to work independently and manage multiple audits simultaneously. • Strong communication skills to effectively present findings and collaborate with other departments. • Proficiency in audit software, Microsoft Office Suite (Excel, Word), and claims management systems.