Job description
Pennsylvania Workers’ Compensation Billing Specialist
Position Summary
MUST LIVE IN NJ, PA, OR FL
We are seeking an experienced Pennsylvania Workers’ Compensation Billing Specialist to manage billing and accounts receivable for our Pennsylvania Workers’ Compensation claims. This is not a general medical billing position — the ideal candidate will have direct experience with Pennsylvania Workers’ Compensation billing, collections, and claim follow-up and understand the unique requirements involved in obtaining reimbursement from Workers’ Compensation carriers and third-party administrators.
This position is responsible for the A/R lifecycle, including claim payment and denial review, carrier follow-up, underpayment identification, appeals, and resolution of outstanding balances.
We are looking for someone who is persistent, organized, comfortable working difficult claims, and understands that a claim is not resolved simply because a bill was submitted.
Key Responsibilities
Manage billing and accounts receivable for Pennsylvania Workers’ Compensation claims
Perform consistent follow-up on outstanding, unpaid, and underpaid Workers’ Compensation claims
Communicate directly with insurance carriers, third-party administrators (TPAs), adjusters, nurse case managers, and other claim representatives to resolve outstanding balances
Review payments and remittance documentation for accuracy and identify inappropriate reductions, denials, and underpayments
Research and resolve denied or rejected bills, including issues related to claim information, authorization, compensability, documentation, coding, and billing requirements
Prepare and submit reconsiderations, appeals, corrected bills, and supporting documentation when appropriate
Identify discrepancies between billed charges, expected reimbursement, and actual payments
Maintain accurate and detailed account notes documenting all collection activity and follow-up
Work Workers’ Compensation aging reports systematically and prioritize accounts requiring immediate action
Obtain and verify necessary claim information, including carrier/TPA, adjuster information, claim numbers, dates of injury, and authorization information
Identify recurring denial and payment trends and escalate systemic issues to management
Collaborate with coding, authorization, clinical, and front-end teams to resolve issues affecting reimbursement
Maintain consistent account follow-up and meet established productivity and A/R performance expectations
Qualifications
MUST LIVE IN NJ, PA, OR FL
Previous Pennsylvania Workers’ Compensation medical billing and/or A/R experience strongly preferred
Working knowledge of the Pennsylvania Workers’ Compensation billing process and fee schedule
Experience communicating with Workers’ Compensation carriers, TPAs, and adjusters
Experience researching and resolving denials, reductions, underpayments, and unpaid claims
Ability to interpret EOBs/EORs and determine the appropriate next step toward resolution
Familiarity with medical billing, CPT/HCPCS and ICD-10 terminology
Experience using EHR/practice management systems and electronic billing platforms
Strong attention to detail and documentation skills
Persistent and comfortable with high-volume claim follow-up and collection activity
Ability to independently research problems and see accounts through to resolution
Must have a minimum of a high school diploma or equivalent
Preferred Skills
2+ years of Pennsylvania Workers’ Compensation billing or collection experience
Experience working Workers’ Compensation claims for a specialty medical practice
Experience in neurosurgery, orthopedics, pain management, physical therapy, or other surgical/specialty care
Experience handling high-dollar surgical or procedural claims
Strong understanding of denial and underpayment trends and the ability to identify root causes
Strong organizational and prioritization skills
Confident and professional communication skills when working with adjusters, carriers, TPAs, providers, and internal teams
Experience managing a dedicated Workers’ Compensation A/R inventory from initial billing through final resolution
Work Environment
Full-time position
In-office, remote, or hybrid
High-volume medical billing and accounts receivable environment
Position requires consistent follow-up, independent problem-solving, and accountability for assigned Workers’ Compensation accounts
We are an equal opportunity employer and value diversity at all levels of the organization.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.