923 Best Office & Admin Jobs in Plano, Texas (January 2026) - page 10

ACCOUNTS RECEIVABLE SPECIALIST WORKERS COMPEN

4 days ago

Plano

Job Description About Legent Health At Legent Health, our mission is simple yet profound: “To provide first-class health care that puts YOU first.” Our vision reflects our commitment to excellence: “Through robust physician partnerships, become a nationwide leader in compassionate, quality healthcare focused on the patient and available to everyone.” Our values, also known as our brand pillars, define how we stay true to our identity in the healthcare industry and the communities we serve. These values are central to everything we do: • Respect: We honor the time and trust of both patients and physicians by delivering organized, efficient services that ensure a seamless healthcare experience., • Service: We are committed to highly personalized care for patients, their families, and the physicians who serve them, driving optimal outcomes for all. About the Role The AR Specialist - Texas Workers' Compensation will manage the complete revenue cycle for workers' compensation surgical claims at our specialty surgical facilities, focusing on spine, orthopedic, ENT, and pain management procedures. This role serves as the primary liaison between our facility and workers' compensation carriers, employers, adjusters, and case managers to expedite claim resolution and optimize reimbursement for services rendered. POSITION’S ESSENTIAL RESPONSIBILITIES: Primary Claims Management: • Manage surgical workers' comp claims from authorization through payment - Track all workers' compensation surgical cases from initial scheduling through final reimbursement, • Collaborate with Verification of Benefits team - Assist in reviewing compensability determinations, confirming active claim status, and identifying red flags that could impact payment, • Partner with coding team on documentation - Review operative reports and clinical documentation to ensure medical necessity is clearly established and services are appropriately coded, • Build strategic relationships with adjusters at major carriers to facilitate faster claim processing, • Coordinate with nurse case managers to ensure surgical procedures are properly authorized, • Engage with employer representatives when appropriate to clarify coverage issues or expedite approvals, • Maximize reimbursement under Texas fee schedules for surgical procedures, implants, and ancillary services, • Appeal underpayments and denials - Identify payments below fee schedule requirements or incorrect surgical reimbursement calculations, • Manage stop-loss and outlier provisions for high-cost surgical cases, • Track implant and device costs - Ensure proper billing for surgical implants, biologics, and high-cost medical devices, • Preauthorization and Compliance:, • Navigate preauthorization requirements - Work with clinical teams to obtain all required authorizations before surgery, • Manage concurrent review requirements for procedures requiring ongoing authorization, • Handle peer-to-peer reviews - Facilitate physician discussions to support medical necessity, • Spine procedures - Manage complex spine surgery claims including fusions, disc replacements, and neurostimulator implants, • Orthopedic surgery - Handle joint replacements, arthroscopic procedures, and fracture repairs, • Pain management - Process claims for epidural injections, nerve blocks, and spinal cord stimulator trials/implants, • Track carrier-specific payment patterns and denial reasons, • Identify process improvement opportunities based on denial patterns, • Maintain detailed account notes documenting all payer interactions, • Exceptional relationship-building skills with adjusters, case managers, and employer representatives, • Strong collaborative approach working with internal teams (verification, coding, clinical), • Expert knowledge of surgical reimbursement and Texas workers' comp fee schedules, • Negotiation and advocacy skills to professionally advocate for appropriate reimbursement, • Understanding of surgical procedures in spine, orthopedic, ENT, and pain management, • Workers' comp billing expertise including preauthorization and carrier-specific requirements, • Problem-solving orientation to identify payment issues and develop solutions, • Excellent communication skills with external partners and internal teams, • Detail-oriented with strong follow-through and systematic claim tracking, • Technology proficiency with practice management systems and workers' comp portals, • Customer service mindset understanding employers and adjusters as customers, • Experience in multi-specialty surgical facilities with high-dollar spine and orthopedic cases (Preferred), • Established relationships with major Texas workers' comp carriers and TPAs (Texas Mutual, Travelers, Sedgwick, Gallagher Bassett, CorVel) (Preferred), • Knowledge of specific surgical authorization requirements for complex procedures (Preferred), • Experience with both in-network and out-of-network negotiations (Preferred), • Understanding of ODG (Official Disability Guidelines) and Milliman care guidelines (Preferred), • Certification in healthcare revenue cycle (CRCR) or workers' compensation (CWCP) (Preferred), • Bilingual (English/Spanish) to communicate with diverse injured worker populations (Preferred) EDUCATION AND EXPERIENCE REQUIREMENTS: • Minimum 3-5 years of workers' compensation billing experience in a surgical facility setting (ASC or hospital outpatient preferred), • Proven experience working surgical workers' comp claims for spine, orthopedic, or pain management procedures, • Demonstrated success building relationships with adjusters and case managers, • Experience collaborating with clinical teams for documentation and authorizations, • Track record of successful claim resolution including appeals and negotiations Legent Health fosters an environment where team members are empowered to deliver exceptional care while growing professionally within a supportive, values-driven culture. We Offer: • Competitive salary and performance incentives, • Comprehensive benefits package, • Paid time off and wellness programs Legent Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, disability status, or any other legally protected characteristic. I-9 and E-Verify Compliance: Employment eligibility will be verified through the U.S. Department of Homeland Security’s E-Verify system. All applicants must provide valid documentation to establish identity and authorization to work in the United States, as required by federal law.

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