Workers Compensation Specialist

To support the AMG Workers Compensation Program, Atlantic Workers’ Compensation Covid Recovery Center, and to act as a liaison between all Atlantic entities and our Workers' Comp Managed Care Partners/Workers' Comp insurance carriers.


Principal Accountabilities:

• The Workers’ Compensation Specialist will act as a liaison between the entry point of a Workers’ Compensation claimant and all pertinent outpatient facilities involved. 
• The Worker Compensation Specialist will also be the liaison for Workers’ Compensation Insurance Companies and specialty providers to ensure a seamless transition of information, authorizations, and any other identified documents.
• Gathers all documentation from visits and submits to the claims’ adjusters and nurse case managers as required.
• Fields medical records requests systemwide for work related services.
• Obtains all authorizations for services, documents approvals within the Electronic Medical record, and coordinates and schedules all approved services.
• Provides case coordination and oversight in order to streamline and expedite the provision of medical services to maintain good relationships with insurance carriers and Atlantic Health System.
• Facilitates all adjuster and nurse case management needs and requests to ensure recurrent referrals.
• Ensures needs of patients are being met and that quality customer experiences and outcomes are being delivered.
• Provides education and support to providers and providers' staff to ensure proper pre-service, documentation, and authorizations processes are followed. May require travel.
• Works alongside Corporate Health and Managed Care to assist in any other directed care cases as needed, including, but not limited to, executive health, occupational health placed practices as well as international, self pay, and vendor bundled cases.
• Assists Corporate Health business development leadership with day to day requests, services issues, and provider relations follow ups.
• Works alongside urgent care and initial care sites to track and capture leakage of patients to ensure continuity of care within Atlantic Health System.
• Monitors and completes work queue tasks for injured workers entering system through our urgent cares, systemwide.
• Assists in the development of educational content used for provider training for quarterly and yearly webinar/in person trainings. 
• Compiles daily/weekly/monthly data of incoming referrals and indemnity outcomes.
• Creates Episodes of care.
• Compiles and distributes reports as requested.
• Participates in project based work as requested.

Education/Experience 

1. Bachelor's degree preferred, High School Degree Required.
2. Physician office experience preferred
3. Must have Worker’s Compensation Insurance experience
4. Proficiency in all Microsoft Office applications
5. Excellent organizational and workflow skills essential
6. Must be available to travel to multiple locations

COMPETENCIES:

1. Successful track record of handling Workers’ Compensation cases from start to finish
2. Demonstrated knowledge of medical terminology
3. Excellent interpersonal communication to maintain positive and productive working relationships
4. Proficiency with data collection, analysis and reporting
5. Demonstrated ability to successfully manage multiple tasks simultaneously demonstrating flexibility and creativity.