Occupational Health - Occupational Health Claims & Revenue Cycle Specialist - FT - 1st Shift Job Listing at Wilson Health in Sidney, OH (Job ID 8a78839ea150ae2901a182d11dc347f6)

Description

Wilson Health is looking for a direct hire Occupational Health Claims & Revenue Cycle Specialist our location in Sidney, Ohio (North Dayton, Ohio) area.   Key Perks and Benefits:

• Access to Employer Direct Care Clinic. Free medical care and pharmacy services for eligible employees and dependents covered by Wilson Health's medical insurance plan.
• Generous paid time off (PTO) program beginning day one, designed to support work-life balance, rest, and time with family.
• Medical Insurance: Choose from two High-Deductible Health Plan (HDHP) options or a PPO plan, along with Dental and Vision coverage. Benefits begin on the first of the month following your hire date.
• HSA with employer contribution for eligible health plans; FSA for medical and dependent care expenses.
• Company-paid Life Insurance and Long-Term Disability Insurance
• Voluntary Accident, Critical Illness, and employee and dependent Life and AD&D Insurance.
• Industry-leading retirement plan – employer contributions begin day one with no waiting period for participation.
• Tuition Assistance Program
• Free access to an on-site gym, available 24/7, making it easy to prioritize your health and wellness before or after your shift.
• Employees receive a 10% discount on food and beverages at the Wilson Cafeteria, Coffee Bar and Micro Mart.

Who We Are: At Wilson Health, our mission is to improve the health and wellness of our communities by delivering compassionate, quality care. We are committed to making a difference for our neighbors, friends, and family and our vision is to be a trusted, nationally-recognized leader of innovative, collaborative community health.    Employment Status: FULL-TIME Working Hours: 40 hours a week/80 hours per pay period Shift: 1st shift Position Reports to: Occupational Health Manager   Position Summary Wilson Health is seeking an organized, detail-oriented professional to join our team as an Occupational Health Claims & Revenue Cycle Specialist. This position supports workers' compensation claims administration, occupational health services, care coordination, medical billing, coding, and revenue cycle operations. The Specialist serves as a central resource for coordinating claims, managing medical documentation, processing billing and reimbursement activities, and facilitating communication among healthcare providers, employers, insurance carriers, Managed Care Organizations (MCOs), attorneys, and injured workers. The ideal candidate has experience in healthcare billing, workers' compensation, claims processing, or occupational health and possesses strong analytical, organizational, communication, and problem-solving skills. Essential Duties and Responsibilities Workers' Compensation Claims Administration

• Manage workers' compensation claims from initial injury reporting through ongoing treatment and claim resolution
• Review injury reports, medical records, treatment notes, and supporting documentation for accuracy, completeness, and compliance.
• Process and distribute workers' compensation forms, including C-9 treatment requests, MEDCO-14 forms, work status reports, imaging reports, and follow-up visit documentation.
• Submit required documentation to the Ohio Bureau of Workers' Compensation (BWC), Managed Care Organizations (MCOs), employers, attorneys, and other authorized parties.
• Monitor claim status, track submission deadlines, and follow up on missing information to minimize processing delays.
• Maintain accurate and confidential claim records in accordance with applicable regulations and organizational policies.

Occupational Health and Care Coordination

• Coordinate follow-up medical care for injured workers following Emergency Department, Urgent Care, and Occupational Health visits.
• Schedule appointments and coordinate referrals to specialists, diagnostic services, physical therapy, and other healthcare providers.
• Facilitate communication among providers, employers, MCOs, and injured workers regarding treatment plans, authorizations, work restrictions, and return-to-work status.
• Monitor referral outcomes and assist with continuity of care.
• Help injured workers understand appointment requirements, follow-up care, and workers' compensation procedures.

Medical Billing, Coding, and Revenue Cycle Management

• Generate and process invoices for occupational health services, employer-based clinics, executive physicals, and other applicable services.
• Review clinical documentation and apply appropriate CPT, HCPCS, ICD-10, and revenue codes to support accurate billing and reimbursement.
• Prepare and review CMS-1500 and UB-04 claim forms, as applicable.
• Review procedure documentation to ensure accurate charge capture for examinations, wound care, injections, laboratory services, imaging, testing, supplies, and other billable services.
• Build, review, and process workers' compensation billing batches and electronic claim submissions.
• Submit electronic claims through established billing platforms and resolve submission errors or incomplete billing information.
• Coordinate commercial insurance billing and respond to payer requests for supporting documentation.
• Identify and assist in resolving billing discrepancies, claim denials, and reimbursement delays.
• Collaborate with providers and clinical staff to obtain documentation necessary for accurate coding, charge capture, and reimbursement.

Insurance, Employer, and Stakeholder Relations

• Serve as a primary point of contact for employers, insurance carriers, MCOs, healthcare providers, BWC representatives, attorneys, and injured workers.
• Respond to inquiries regarding claim status, treatment authorizations, medical documentation, billing, and reimbursement.
• Coordinate the exchange of medical and claims information in accordance with applicable privacy regulations.
• Process authorized medical records requests and compile supporting documentation for legal proceedings when appropriate.
• Establish and maintain positive working relationships through timely communication, professionalism, and customer service.

Administrative and Departmental Support

• Retrieve, organize, and distribute incoming mail and time-sensitive documentation.
• Route billing, payment, reimbursement, and workers' compensation paperwork to the appropriate departments.
• Coordinate the delivery and processing of imaging registration paperwork and other required clinical documentation.
• Ensure medical records, billing documents, and claims information are distributed accurately and promptly.
• Maintain organized records and support efficient departmental workflows.

Minimum Qualifications

• High school diploma or equivalent required.
• Three (3) years of experience in healthcare billing, revenue cycle management, workers' compensation administration, claims processing, occupational health, or a related healthcare field.
• Working knowledge of medical terminology, anatomy and physiology, and medical coding principles, including CPT, HCPCS, and ICD-10.
• Experience working with insurance carriers, Managed Care Organizations, workers' compensation claims, or healthcare reimbursement processes.
• Proficiency with Microsoft Office applications and electronic medical record systems.
• Strong organizational skills with the ability to manage multiple priorities, competing deadlines, and complex workflows.
• Excellent written and verbal communication skills.
• Strong analytical, problem-solving, and critical-thinking abilities.
• Exceptional attention to detail and commitment to accuracy.
• Ability to maintain confidentiality and exercise discretion when handling sensitive medical and claims information.
• Ability to work independently and collaborate effectively with internal and external stakeholders.

Preferred Qualifications

• Associate degree in Healthcare Administration, Health Information Management, Business Administration, Medical Billing and Coding, or a related field.
• Professional certification such as Certified Professional Coder (CPC), Certified Coding Associate (CCA), Certified Billing and Coding Specialist (CBCS), Registered Health Information Technician (RHIT), or an equivalent credential.
• Experience with Ohio Bureau of Workers' Compensation (BWC) claims administration.
• Previous experience in Occupational Health, Employee Health, Revenue Cycle, or Workers' Compensation services.
• Knowledge of CMS-1500 and UB-04 claim forms, electronic claim submission processes, and healthcare reimbursement methodologies.
• Experience with Quadax, Xpeditor, Systoc EDI, or comparable billing and claims management platforms.

Knowledge, Skills, and Abilities

• Knowledge of workers' compensation claims processes, regulatory requirements, and reimbursement procedures.
• Understanding of healthcare billing, coding, charge capture, and revenue cycle operations.
• Ability to interpret clinical documentation and identify missing or incomplete information.
• Strong communication and customer service skills when working with providers, employers, insurers, attorneys, and injured workers.
• Ability to manage detailed documentation, competing priorities, and time-sensitive submissions.
• Demonstrated commitment to accuracy, regulatory compliance, confidentiality, and continuous improvement.

Supervisory Responsibilities This position has no direct supervisory responsibilities. Work Environment and Physical Requirements The position primarily operates in an office environment with a low-to-moderate noise level associated with telephone calls and routine departmental activity. The role requires regular use of a computer and telephone, along with occasional movement throughout the hospital to retrieve, distribute, or coordinate documentation. Physical demands may include sitting, standing, walking, typing, reaching, bending, and occasionally lifting or carrying light items. Why Join Wilson Health? At Wilson Health, we are committed to improving the health and wellness of our communities by delivering compassionate, quality care. Our team members play an essential role in supporting patients, providers, employers, and the communities we serve. When you join Wilson Health, you become part of a team committed to professionalism, integrity, respect, and excellence. Join Wilson Health and make a difference in the coordination of occupational health services, the support of injured workers, and the delivery of quality healthcare. Mission & Vision & Values:

• Improve the health and wellness of the community by delivering compassionate, quality care.
• Be a trusted, nationally recognized leader of innovative, collaborative, community health.
• A.S.P.I.R.E - Always serve with professionalism, integrity, respect, and excellence.

EOE (Equal Opportunity Employer)

 Apply on company website