Transcend Health Solutions, LLC · 1 week ago
WC (Workers Compensation) Claims Analyst
United States
Full-time
Remote
Entry, Mid Level
$48K/yr - $55K/yr
2+ years expTranscend Health Solutions, LLC is focused on maximizing claims revenue for their customers through efficient claims management. They are seeking a Workers' Compensation Claims Analyst to investigate, submit, and resolve WC claims while ensuring compliance with state-specific statutes and maintaining effective communication with all stakeholders.
Hospital & Health Care
Responsibilities
Review and process WC claims by gathering medical records, itemized bills, and employer/patient information
Submit claims to WC carriers in accordance with state-specific statutes and billing rules
Verify eligibility, claim status, and payer responsibility with adjusters and employers
Communicate professionally with insurance adjusters, employers, and patients to resolve claim barriers and expedite processing
Review Explanation of Benefits (EOBs) or remittance advices for accuracy and next steps
Prepare and submit appeals when claims are denied or underpaid, referencing applicable WC rules and documentation
Ensure all activities are documented clearly and timely in claim management systems
Maintain compliance with HIPAA and confidentiality standards
Escalate complex claim issues or legal barriers to leadership as needed
Meet productivity goals while maintaining excellent attendance, attention to detail, and accuracy
Qualification
Required
Expert knowledge of WC claims processes, including writing effective appeals and reconsiderations
Strong knowledge of medical terminology, coding (ICD-10, CPT, HCPCS), and healthcare billing principles
Excellent communication and problem-solving skills
Strong working knowledge of workers' compensation statutes and regulations in multiple states (e.g., FL, GA, AL, OK, MO, TX)
Experience handling WC claims from submission through resolution
Proficiency in interpreting EOBs, state fee schedules, and medical documentation
Ability to communicate clearly and professionally with adjusters, employers, patients, and healthcare providers
Highly organized and detail-oriented with excellent follow-up skills
Proven track record of excellent attendance and reliability
High School Diploma required; Bachelor's degree preferred, or equivalent combination of education and experience
Minimum of 2 years' experience in VA claims, medical billing, or claims resolution
Preferred
Familiarity with WC-specific portals (e.g., Georgia SBWC, Corvel, Georgia DOL, etc.)
Experience with hospital lien filing and coordination of benefits
Proficiency in Microsoft Office
Knowledge of medical terminology and ICD-10/CPT coding
Understanding of WC authorization and referral processes
EHR experience
Company
Transcend Health Solutions, LLC
Transcend Health Solutions specializes in revenue cycle management (RCM) services.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
W. Charles Day
Chief Executive Officer
Stephen Ingram
Chief Technology Officer
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