Workers Compensation Representative

Worker's Compensation Specialist

General Job Summary: Responsible for all aspects of worker's compensation. Essential Job Functions: Answer and return incoming worker's compensation calls in a timely, courteous manner. Intake all injured worker's information including patient demographics. Verify, re-verify and pre-authorize worker's compensation claims with the employer, nurse case manager, and/or insurance carrier. Responsible for case management of the injured worker's claim. Address all issues regarding work status report questions and concerns to the provider's specifications and requirements. Responsible for preparing the work status reports for upcoming appointments. Responsible for precertification and tracking of pre-certifications for all ordered tests, surgeries, and referrals of worker's compensation patients. Responsible for tracking, completing, and/or faxing disability forms for Worker's Compensation patients. Assist with informing employers, nurse case managers, and Occupational Medical Facilities about our worker's compensation program and policies to ensure them that COC should be their orthopaedic choice. Review workers compensation accounts receivables and respond to billing companies request for information. Compliance with HIPAA guidelines. Demonstrated passion for excellence with respect to treating and caring for customers in-person and over the phone. Establish and maintain effective working relationships with patients, providers, co-workers, and outside referrals. Performs other duties that may be necessary or in the best interest of the practice.

Requirements: Education/Experience: High School Diploma plus one to three years experience in the procedures of worker's compensation and one to three years of medical billing or coding experience (preferably in Orthopaedics). Other Requirements: Schedules will change as department needs change, including overtime and weekends. Travel as needed. Performance Requirements: Knowledge: Knowledge of HIPAA regulations. Knowledge of worker's compensation policies and regulations. Basic to intermediate knowledge and familiarity with coding procedures and diagnosis. Knowledge of practice management and electronic health records systems. Skills: Accuracy in data entry. Detail oriented. Excellent adaptability skills. Abilities: Ability to work under pressure with time constraints. Ability to work effectively and deal courteously with patients, staff, and others. Ability to enter accurately data and examine insurance documents. Can work independently with minimal or no supervision. Equipment Operated: Standard office equipment. Work Environment: Office environment. Required Physical Demands: Involves sitting approximately 90 percent of the day in front of a computer. Fast paced and high productivity environment. Must be able to lift about 20 pounds.