Worker's Compensation Auditor - Titan Healthcare Management Solutions

Title:                     Worker’s Compensation Auditor	Location:                          Remote
Reports To:                  Reimbursement Audit Supervisor	Date Revised:                          10/4/2024
Department:                Zero BalanceAuditing	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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