Workers Compensation Representative

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.
• Case manage the injured worker’s claim.
• Address all issues regarding work status report questions and concerns to the provider’s specifications and requirements.
• Prepare the work status reports for upcoming appointments.
• Track, complete, and/or fax disability forms for Worker’s Compensation patients.
• Avoidance of HIPAA violations.
• Establish and maintain effective working relationships with patients, providers, co-workers, and outside referrals.

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.