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# Job Title: Appeal Representative – US Workers’ Compensation Billing

**Department:** Revenue Cycle Management / Accounts Receivable

**Process:** US Workers’ Compensation

**Location:** India – Remote / Work From Office

**Shift:** US Shift / Night Shift

**Experience:** 1–4 years in US Healthcare RCM preferred

**Employment Type:** Full-Time

## Job Summary

We are looking for an experienced **Appeal Representative** to handle denied and underpaid claims within the **US Workers’ Compensation billing process**.

The ideal candidate should have good knowledge of Workers’ Compensation claims, denial management, medical billing, claim status follow-up, appeals, and payer/TPA requirements. The candidate will be responsible for reviewing denied claims, identifying the root cause, gathering supporting documentation, preparing and submitting appeals, and following up until resolution.

## Key Responsibilities

* Review denied, rejected, and underpaid Workers’ Compensation claims.

* Analyze EOBs/ERAs, denial codes, bill review results, and payer/TPA correspondence.

* Identify the reason for denial and determine the appropriate resolution.

* Prepare and submit professional and well-supported claim appeals.

* Follow up with insurance carriers, TPAs, bill review companies, and other Workers’ Compensation entities.

* Review claim documentation, medical records, authorization information, and billing history when required.

* Research claim status and payment information through payer portals and other available resources.

* Work on **California Workers’ Compensation** claims and understand basic WC billing requirements.

* Review and work claims involving **EAMS, QME-related documentation, Bill Review, SBR/IBR, TOR, and other WC-specific processes**.

* Identify incorrect reductions, bundling issues, fee schedule discrepancies, authorization issues, and other payment-related problems.

* Prepare reconsiderations, appeals, disputes, and supporting documentation based on the denial reason.

* Maintain accurate account notes and document every follow-up action.

* Prioritize accounts based on aging, dollar value, denial type, filing deadlines, and client requirements.

* Escalate complex claims appropriately to management or the client.

* Meet daily productivity, quality, and turnaround-time targets.

* Maintain compliance with client SOPs and HIPAA/privacy requirements.

* Coordinate with internal billing, coding, payment posting, and AR teams when additional information is required.

## Preferred Knowledge

Candidates should preferably have knowledge of:

* US Healthcare Revenue Cycle Management (RCM)

* Workers’ Compensation billing

* Denial management and appeals

* AR follow-up

* EOB/ERA interpretation

* Medical billing and reimbursement

* California Workers’ Compensation

* Bill Review

* SBR / IBR

* EAMS

* QME-related processes

* TPA and insurance portals

* Workers’ Compensation fee schedules

* Claim status and payment research

* Appeal and reconsideration processes

## Required Skills

* Strong written and verbal English communication

* Good analytical and problem-solving skills

* Ability to interpret denial reasons and determine the correct action

* Strong attention to detail

* Good documentation and account-note skills

* Ability to work independently

* Good computer and internet skills

* Ability to work in a US night-shift environment

* Ability to manage multiple accounts and deadlines

## Experience

**Preferred: 1–4 years of experience in US Healthcare RCM.**

Candidates with experience in any of the following areas will be preferred:

* Workers’ Compensation AR

* Denials & Appeals

* Medical Billing

* Insurance AR

* Payment Posting

* Claim Follow-up

* US Healthcare Collections

* California Workers’ Compensation

Candidates with strong US healthcare AR experience but limited Workers’ Compensation experience may also be considered.

## Performance Expectations

The selected candidate will be expected to:

* Meet assigned daily productivity targets.

* Maintain high claim-resolution accuracy.

* Submit complete and timely appeals.

* Follow client-specific SOPs.

* Maintain accurate account documentation.

* Meet quality and compliance requirements.

* Demonstrate consistent follow-up until claim resolution.

## Shift & Work Environment

* **US Night Shift**

* Full-time position

* Work-from-office or remote depending on business requirements

* Candidates should be comfortable working during US business hours.

* Stable internet connection and basic computer proficiency required for remote work.

## What We Offer

* Opportunity to work directly on US Healthcare / Workers’ Compensation RCM processes.

* Exposure to complex denial and appeal workflows.

* Career growth within the Revenue Cycle Management domain.

* Performance-based growth opportunities.

* Training and process-specific guidance.

How to Apply

Interested candidates can share their **updated resume** along with their total experience, relevant US healthcare/Workers’ Compensation experience, current location, and expected salary.

**Subject:** Application – Appeal Representative – Workers’ Compensation

• It is a Full Time కస్టమర్ మద్దతు / టెలికాలర్ job for candidates with 1 - 3 years of experience.