Pennsylvania Workers’ Compensation Medical Billing Specialist

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.