Worker's Compensation Coordinator - Center for Orthopaedics

GENERAL SUMMARY OF DUTIES:

The purpose of this position is to coordinate the management of workers' compensation patients by being the point of contact for all workers' comp cases referred to CFO and obtain prior authorizations for all workers comp appointments/ procedural orders by successfully completing the workers compensation authorization process.

ESSENTIAL FUNCTIONS:

1. Developing and maintaining positive working relationships with referring providers, patients, case managers, adjusters, employers, and payors.
2. Verify patient demographics and billing information and enter all new worker's comp cases into Practice Management System.
3. Verifies and obtains prior approvals from employer/carrier for all services provided under worker's compensation.
4. Coordinates and schedules worker's comp patient appointments and rehab conferences.
5. Acts as a liaison between the employer, worker's comp carrier, and physician.
6. Maintain detailed organizational system of all worker's compensation cases and performs timely follow-up to check the status of authorization request.
7. Reviews, verifies, and transmits work status and other reports on all worker's comp appointments.
8. Notate patient account and notify all necessary parties regarding status of authorizations.
9. Uploads all payer correspondence related to prior authorization to patient account.
10. Initiate appeals for denied pre-authorization requests as needed.
11. Maintain detailed organizational system of all worker's compensation cases and performs timely follow-up to check the status of appointment approvals.
12. Responds to any worker's comp medical records requests from worker's comp carriers and/or employers in a timely manner.
13. Daily checking of emails and voicemails to ensure prompt responses to all work comp inquiries and patient needs.
14. Performs other related duties as assigned and serves in whatever other capacity deemed necessary for successful completion of the mission and goals of CFO.

KNOWLEDGE:

1. Knowledge of workers compensation authorization process and its direct impact on the practice's revenue cycle.
2. Comprehension of workers compensation medical policy guidelines.
3. Basic understanding of human anatomy, specifically musculoskeletal.
4. Proficient use of CPT and ICD-10 codes
5. Detail oriented with above average organizational skills.
6. Plans and prioritizes to meet deadlines.
7. Excellent customer service skills: outstanding ability to interact positively with physicians, staff, and "external" customers.
8. Ability to multitask and perform tasks in a productive, timely, and accurate manner while managing a high-volume, time-sensitive workload.

EDUCATION:

High school diploma or equivalent

EXPERIENCE:

1. Clinical experience preferred
2. Moderate level of computer skills including EMR (electronic Medical record), Practice Management system, basic office applications including Outlook, Word, Excel and use of the internet.
3. Customer service experience; preferably in a healthcare related environment.
4. One year's relevant work experience in a medical office setting or related workers' compensation.

ENVIRONMENTAL/WORKING CONDITIONS: Office setting. Frequent telephone calls and other interruptions, which requires being able to handle a fast-paced work environment during entire time at work. Must be able to prioritize multiple projects. Must maintain strict confidentiality according to the HIPAA standards of privacy and security and exercise professionalism when interacting with staff, managers, supervisors, physicians, external customers, etc.

PHYSICAL/MENTAL DEMANDS: Requires continuous standing, sitting, frequent walking, bending, and stooping. Physical ability to perform data entry and view computer screen for long periods. May require lifting of 50 to 100 pounds. Possible exposure to Hazardous Materials/conditions and infectious diseases.