Role Description As a Workers' Compensation Claims billing specialist at Revecore, you will: - Make high-volume, outbound calls to investigate, bill, and maximize payments on medical claims to insurance companies, on behalf of our clients (hospitals and medical providers). - Investigate and resolve problem and/or denied workers' compensation claims. - Submit bills and proper documentation to the insurance company or appropriate payer, ensuring maximized payments to our clients (medical providers). - Review information/documentation provided by the payer to determine next steps if bills aren't paid correctly. - Participate in special projects to achieve goals and ensure client success. Responsibilities - Have a working knowledge of Microsoft Office (Word, Excel, Outlook). - Possess technical proficiency to work on multiple computer screens and software applications simultaneously. - Maintain strong performance in a fast-paced environment with productivity metrics. - Remain organized while multi-tasking. - Use critical thinking and problem-solving skills to find effective and efficient solutions. - Communicate clearly, both verbally and in writing. - Possess an investigative mindset. - Have experience with Coordination of Benefits and a general understanding of insurance billing (a plus, but not required). How we'll set you up for success - Extensive multi-week training with ongoing support from teammates following training. - Access to a robust knowledgebase for continued reference in your role. - Visibility to your individual performance metrics enables you to set goals. - Computers and necessary work equipment are provided. - Involved management who leans in to support your productivity metrics. Training Our comprehensive training begins on your first day and lasts 8-10 business days. It is led by instructors and incorporates interactive discussions and hands-on activities to accommodate diverse learning preferences. Success starts with training. That's why we ask all new team members to be fully present each day, participate actively, and remain on camera. Work at Home Requirements - A private, distraction-free environment to work from within your home. - On-camera presence: Being on camera is an essential part of our culture - it helps build trust, support collaboration, and strengthen team connections. - A secure internet connection. - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. - Workspace area must accommodate all workstation equipment (laptop, monitor, keyboard, mouse, docking station, and headset). Requirements - Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check. - Must reside in the United States within one of the states listed below: - Alabama - Arkansas - Connecticut - Florida - Georgia - Indiana - Iowa - Kansas - Kentucky - Louisiana - Maine - Massachusetts - Michigan - Minnesota - Mississippi - Missouri - Nebraska - New Hampshire - North Carolina - North Dakota - Ohio - Oklahoma - Pennsylvania - Rhode Island - South Carolina - South Dakota - Tennessee - Texas - Vermont - Virginia - West Virginia - Wisconsin

• Review, evaluate, and adjudicate claims in accordance with contract terms and company guidelines • Audit Parts and labor submissions to ensure accuracy, reasonableness, and compliance with repair standards • Accurately document claim files with clear defensible notes • Prioritize and manage claim workloads to ensure timely resolution of open items • Communicate claim determinations professionally to dealers, servicers, and customers • Coordinate servicer setup documentation including W9 collection and validation • Apply technical knowledge of multi-line powersports units to evaluate repair scope and validity • Identify discrepancies in repair orders, parts usage, and labor times • Work collaboratively with internal departments to ensure consistent policy application • Provide input to improve existing procedures and systems

• Investigate, evaluate, and adjust PIP claims in accordance with Texas laws and company guidelines • Obtain information necessary to properly investigate and evaluate each case by corresponding with brokers, insureds, claimants, witnesses and others • Analyze medical records, billing, and documentation to determine coverage, liability, and damages • Ensure compliance with Texas Department of Insurance regulations and statutory deadlines • Handle complex and litigated PIP claims, including disputes and arbitration • Communicate effectively with claimants, attorneys, medical providers, and internal stakeholders • Review and negotiate medical bills and treatment plans for reasonableness and necessity • Identify potential fraud indicators and escalate as appropriate • Maintain accurate and timely claim file documentation • Provide guidance and mentorship to junior adjusters as needed • Manage claim inventory to meet productivity and quality standards

• The Claims Resolution Specialist plays a critical role in the healthcare revenue cycle by ensuring the accurate and timely submission and resolution of insurance and patient claims. • This position is responsible for claim billing, follow-up, and resolution for government, commercial, and patient payers. • The specialist investigates denied or unpaid claims, performs root cause analysis, documents findings, executes appropriate write-offs or corrections, and ensures compliance with payer guidelines and internal policies. • Submit and track insurance and patient claims for government (e.g., Medicare/Medicaid) and commercial payers. • Perform timely and thorough follow-up on unpaid or denied claims to ensure proper reimbursement. • Conduct root cause analysis on recurring denials or payment issues; escalate trends to management as needed. • Research payer policies and claim-specific requirements to ensure accurate claim resolution. • Process write-offs and adjustments according to established protocols and payer contracts. • Maintain clear, accurate, and thorough documentation of all claim-related activities and communications. • Collaborate with clinical, billing, and coding staff to resolve claim issues and ensure accurate claim submission. • Monitor aging reports and prioritize follow-up efforts based on payer deadlines and financial impact. • Prepare reports and summaries of problem accounts, denial patterns, and process inefficiencies for leadership review. • Assist in implementing process improvements to reduce denials and enhance revenue cycle performance. • Ensure compliance with HIPAA, payer guidelines, and internal billing policies. • Performs other duties as assigned.