Workers Compensation Specialist

Key Responsibilities

• Manage workers compensation incoming calls, faxes, emails and referrals
• Communicate effectively with adjusters, nurse case managers, referral sources, and physicians by obtaining or providing requested workers comp information on new or existing patients
• Assists other departments and physician teams by providing or verifying workers comp information when needed
• Responding to and documenting patient cases to ensure proper processing and scheduling
• Submit treatment orders to utilization review companies for approval and follow up to ensure complete authorization process
• Schedule patient appointments and workers comp appointed exams
• Maintain knowledge and education to be effective and productive on prior authorization requirements
• Work with individual department co-workers on special projects as requested by supervisor
• Follow the requests and directions of department Lead, Manager, Director, and physicians
• May be required to assist other areas in referrals/authorizations department when staffing is needed
• Participate in monthly and quarterly meetings within respective department and team to discuss policies, protocols, and best-practices
• Adhere to applicable healthcare laws, regulations, and orthopaedic practice policies and procedures, including requirements related to patient privacy, documentation, billing, and ethical conduct
• Protects patient confidentiality, completes required compliance training, and promptly reports suspected compliance or ethical concerns

Skills and Qualifications

• High School Diploma or equivalent required
• Required knowledge of self-insured and network Workers Compensation programs, rules and regulations
• Proficient computer skills
• Exceptional customer service skills
• Proficient and accurate data entry skills
• Proficient with Microsoft programs (Excel, Word, etc.)
• Ability to communicate effectively
• Excellent research, follow-through and documentation required
• Ability to multi-task, prioritize work and make sound judgements
• Other duties as assigned as necessary and may vary at times, as needed, by your immediate supervisor or as directed by the company
• Requires predictable and consistent attendance

Prolonged sitting. Repetitive motion (data entry), and phone contact.