Work Related Injury Dept Case Manager

Job Title

Coordinates and processes daily communication and documentation to get authorization for treatment or medical procedures for work-related injuries, illnesses, or business-related health care.

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our core values are:

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Essential Functions of the Role

• Obtain authorization for treatment and procedures from insurance agencies, the Texas Workers' Compensation Commission, the Department of Labor, and other agencies to ensure timely patient care.
• Accurately and promptly collect initial demographic patient data from the patient and employer before scheduling non-emergency work-related injury or illness appointments. Maintain and update the OccMed database with required data.
• Approves and coordinates all initial and follow-up appointments in compliance with TWCC or DOL regulations.
• Accurately and promptly prepares all required documentation to comply with TWCC regulations. Utilizes the OccMed database, prints, and mails required forms to all interested parties. Maintains an accurate working file on all patients with a work-related injury or illness in compliance with departmental guidelines.
• Reports work status of patient to appropriate parties in a timely manner.
• Verifies insurance coverage for work-related injuries/illnesses and obtains pre-authorization to ensure timely patient care and payment for services rendered.
• Promptly identifies whether patient's employer is a subscriber to the TWCC.
• Collects all medical documentation needed to obtain pre-authorization/certification from payers in a timely manner.
• Accurately enter all registration and billing information into the computer system. Direct billing to the appropriate payer group before scheduling patient appointments.
• Acts as liaison between patients, providers, and payer groups. Ensures relevant patient information is shared with appropriate parties promptly and professionally.
• Provides problem resolution professionally and quickly. Researches inaccuracies and initiates corrections or clarifications of workers' compensation information or billing.
• Provides additional administrative support to ensure department efficiency and continuity of service.
• Collates data and accurately produces monthly WRID managerial reports.
• Responds promptly and accurately to requests for patient information. If unable to assist, promptly routes calls to the appropriate party or department.
• Serves as manager and liaison to regional clinics for work-related injury and business health care issues. This ensures continuity of service.
• Attends and participates in WRID quarterly staff meetings.
• Effectively educates and supports regional clinics about TWCC/DOL rules and regulations, form preparation, referrals, pre-authorizations and use of SMS systems.
• Assists patients and clients with difficult work-related injury/illness management issues in a professional manner.
• WRID Case Manager specific to Round Rock Region additional duties:
• Preferred certification in Breath Alcohol Technicians (BAT) and urine drug screens.
• Check patients in and out
• Answers inbound calls
• Conduct urine drug screens
• Conduct breath alcohol tests
• Manage referrals
• Correct statement errors
• Submit billing corrections

Key Success Factors

• Knowledge of medical terminology required.
• Microsoft Word or Word Perfect, MS Excel, PowerPoint, Electronic Mail required.
• Two years of college preferred.
• Knowledge of insurance filing and payment methods, to include Texas Workers' Compensation Rules and Regulations preferred.

Qualifications

• Education - H.S. Diploma/GED Equivalent
• Experience - Less than 1 Year of Experience