Worker's Compensation Auditor
Remote
Full Time
Mid Level
| Title: Worker’s Compensation Auditor | Location: Remote |
| Reports To: Reimbursement Audit Supervisor | Date Revised: 10/4/2024 |
| Department: Zero Balance Auditing | Classification: (exempt or non-exempt) Non-Exempt |
About Us:
Join a dynamic and innovative team dedicated to excellence in healthcare reimbursement. At Titan, we are committed to ensuring accurate and timely payments, fostering a collaborative environment where your skills will directly impact our mission of identifying underpayment patterns to maximize revenue recovery for our clients.
Essential Job Duties/Responsibilities
As a Worker’s Compensation Auditor, you will play a pivotal role in ensuring our clients claims are processed accurately and identifying areas where additional revenue can be pursued. Your responsibilities will include:
- 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.
Minimum Qualifications
- 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.
Work Environment
- Work from home: your workspace should be large enough to work efficiently with reliable internet connectivity.
Performance Standards
- Demonstrate a positive and professional demeanor toward supervisors, co-workers, and clients.
- Show commitment and initiative in your role, with a strong focus on job performance and follow-through.
- Deliver high-quality work with attention to detail and accuracy.
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