Workers Compensation Specialist

Job Summary: We are seeking an experienced Workers' Compensation Specialist to work in our Alliance location.  The Workers' Compensation Specialist is the liaison between the patient, insurance carrier, and physician and works in a fast-paced position. 

Onsite role

Key Functions:

• Obtains complete and accurate patient and injury information before scheduling appointments. Creates and maintains a Medical Chart on all workers comp patients.
• Verifies work related injury information with proper employer personnel.
• Verifies eligibility of injury and insurance benefits with insurance carrier representative.
• Translates between provider and patient as needed.
• Obtains correct insurance carrier billing address and claim number if assigned.
• Ensures proper documentation is attached to billing claims before submission or re- submission of the claims.
• Enters complete and accurate demographics into the billing system to ensure proper billing before the patient's first visit.
• Obtains pre-certifications and authorizations for treatment on a daily basis.
•  Ensures completion of all TWCC required forms.
• Performs various collection activities to ensure payment is received and posted for each account. Contacts carriers, patients, or employers as needed to obtain/provide account information.
• Interprets appointment request and schedules patient appointment based on clinic policies. Identifies any problems with making the appointment and advises Physician and/or Manager.
• Checks answering service & reminder call email each morning for patient messages.
• Obtains patient's demographic information, insurance policy and medical issue.
• Informs patient about new patient and payment policies & referrals.
• Verifies insurance for same day add-on appointments.
• Relays relevant information to the Clinic Front Desk, Medical Records and appropriate internal staff when adding or changing an appointment.
• Provides any special needs of the patient to the Physician.
• Answers telephone, screens calls, takes messages, transfers calls to the appropriate area and provides information to keep the patient and clinic staff fully advised regarding appointments scheduled.
• Answers questions regarding patient appointments as requested.
• Makes necessary patient and/or policyholder information corrections in the Appointment System as necessary and advises the Patient and Billing.
• Safeguards patient information and ensures all information remains confidential.
• Request assistance from the Biller or Collectors for difficult account billing questions.
• Participates in office meetings and educational activities.
• Maintains work area in neat and orderly manner.

#AO

Requirements

• High School Diploma or GED, required.
• Must have Worker's Comp experience in a clinical setting-Strongly Preferred
• Referral Intake experience in an ortho setting preferred. 
• Graduate of accredited program in Medical Administration, preferred.
• Knowledge of TWCC rulings and forms strongly preferred.
• Ability to read, understand and master policies and regulations.
• Ability to use patient management systems and computer software (e.g., patient billing & collecting system, electronic medical record system, word processing).
• Ability to interact and communicate well with patients, staff, and vendors.

 Worker's Comp experience and EPIC experience is a PLUS!!!