Workers Compensation Lead (51327)

Worker’s Compensation RCM – Team Lead

Position Summary

The Worker’s Compensation RCM Lead is responsible for optimizing the healthcare billing lifecycle to ensure accurate, timely reimbursement. This role serves as a key liaison between internal teams, vendor partners, insurance payers, and patients, with a strong focus on denial resolution, A/R aging follow-up, and revenue integrity. The Lead works to maximize cash flow while ensuring compliance with payer requirements and organizational policies. The Lead will oversee, train and mentor the WC RCM team.

Key Responsibilities

Team Leadership

• Oversee daily billing and collection activity

• Ensure staff have appropriate tools for maximum productivity

Accounts Receivable Follow-Up

• Billing & Claims Processing: Prepare, review, and submit medical records and billing claims to the appropriate payer. Ensure that procedure was approved by the adjuster or referring payer.

• Claim Accuracy & Follow-up: Verify patient and case information, ensure all required documentation is complete, and follow up on unpaid or denied claims within required timeframes

• Compliance & Confidentiality: Adhere to HIPAA, legal ethics rules, and internal data security policies; maintain confidentiality of all client and patient information

• Account Management: Monitor accounts receivable, reconcile billing records, and identify opportunities for payment recovery. Track claims continuously from service date to final resolution and payment.

• Monitor and balance the work between the lead and other staff members to ensure priority accounts are worked first.

• Review aged WC accounts receivable (30, 60, 90, 120+ days) on a structured weekly and monthly schedule.

• Follow up regularly with insurance adjusters and insurance carriers regarding claim status and payment details.

• Ensure timely responses to patient, adjuster and WC carriers regarding billing, payments, and claim status.

Payment Posting & Reconciliations

• Coordinate with the cash posting team to ensure accurate posting and reconciliation of insurance and patient payments.

• Transfer payments to patient balances when appropriate and notify cash posting for patient refunds in compliance with policy.

• Assist with account reconciliations and discrepancies resolution as needed.

Patient & Insurance Communication

• Act as a liaison between patients and insurance payers to resolve billing questions.

• Clearly explain Explanation of Benefits (EOBs), patient responsibility, and out-of-pocket costs.

• Conduct professional and empathetic phone communication with patients and payer representatives.

Qualifications & Requirements

Education

• High School Diploma or equivalent required

• Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, or a related field preferred

Experience

• Minimum of 5 years of experience in:

• Medical billing and collections

• Accounts Receivable or Revenue Cycle Management

• Healthcare payer follow-up and denial resolution

• Lead/Supervisory experience in an RCM setting

Technical Skills

• Proficiency with Practice Management Systems and Electronic Health Records (EHR/EMR)

• Strong working knowledge of Microsoft Office, particularly:

• Excel (reports, aging analysis)

• SharePoint

Medical & Regulatory Knowledge

• Working knowledge of:

• Medical terminology

• CPT and ICD-10 coding

• Payer guidelines and reimbursement rules for Workers Compensation payers

Core Competencies

• Strong analytical and problem-solving skills

• Exceptional attention to detail and accuracy

• Effective written and verbal communication skills

• Ability to work collaboratively with internal teams and external vendor partners

• Sound judgment related to financial adjustments and account resolution