Worker Compensation Specialist

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

· Reviews worker’s compensation accounts and forms for accuracy and completeness.
· Takes inbound calls from patients and insurance to set up patient charts, schedule appointments.
· Answers questions and provides information pertaining to well-defined areas, which require interpretation of the policy.
· Responsible for sending documentation and orders for each patient visit to the correct carrier.
· Interacts with claims adjustors to verify patient's work status and scheduled appointments.
· Communicates verbally and in writing regarding the interpretation of local and out-of-state guidelines and policies.
· Maintains all records and reports.
· Responds to telephone calls from internal staff, patients, adjusters, and case managers.
· Obtains authorizations for initial visits, surgeries, and physical therapy.

EDUCATION
· High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE
· One-year medical billing or medical business office experience in a physician office or hospital environment; OR
· Worker’s Compensation experience is preferred.

REQUIREMENTS
· Excellent verbal and written communication skills.
· Experience working with Microsoft applications including Word. Excel, and Outlook.
· Ability to work productively in a fast-paced environment.
· Ability to learn and retain company policies, state and federal policies, and workflow processes.

KNOWLEDGE
· Knowledge of worker’s compensation and/or healthcare insurance
· Knowledge of billing and related functions and tasks.
· Knowledge of worker’s compensation processes and requirements.
· Knowledge of payer-specific requirements, state and federal regulations.
· Knowledge of physician group operation and clinic policies.

· Knowledge of authorization and verification processes.

SKILLS
· Skill in the billing authorization process.
· Skill in obtaining necessary approvals for worker’s compensation to reduce denials.
· skill in the collection process for worker’s compensation.
· Skill in Microsoft applications, specifically Excel and Access.

ABILITIES
· Ability to proficiently use arithmetic calculations in data collection and interpretation.
· Ability to use interpersonal skills to establish/maintain cooperative relationships with patients, families, physicians,
management, and other staff.
· Ability to communicate openly and honestly with management and staff.

PHYSICAL/MENTAL DEMANDS
· This can occasionally be a high-stress work area requiring the ability to make quick decisions while being organized and
prioritizing appropriately.
· Requires sitting and standing associated with a normal office environment.
· Some bending and stretching are required.
· Manual dexterity using a calculator and computer keyboard.