Workers Compensation Representative

Overview

General

Job Summary:

Responsible for all aspects of worker’s compensation.

• 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.

• Education/
  
  Experience:
  
  High School Diploma plus 1–3 years experience in the procedures of worker’s compensation and 1–3 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: HIPAA regulations; worker’s compensation policies and regulations; basic to intermediate knowledge of 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.