Workers Compensation Coordinator

• Tracks, coordinate, and communicate patient’s claim.
• Completes registration, including claim information is updated appropriately in EMR software.
• Serves as the point of contact in multidisciplinary evaluation process which includes patient scheduling, third party communications, and internal communications.
• Contacts Worker’s Comp payers to ensure verification of coverage and prior authorization approval requirements are met.
• Communicates with patients on their claim status and coordinates best approach on their ongoing treatment plan.
• Identify problems and find the best solutions to meet patient’s needs/claim.
• Communicates with referral sources for proper handling of referral/claim.
• Manages the states of the accounts and identify/report any inconsistencies.
• Acts as the patient's advocate and address any barriers that prevent the best/compliant care plan.
• Coordinates and communicates potential incoming peer to peer requests and/or additional documentation needs per the payer’s request with internal providers.
• Requests, reviews, and submits necessary patient documentation as needed. e.g. FMLA, narrative reports, DWC073, DWC17 as well as any other necessary paperwork
• Reports statistics as required regarding worker’s compensation claims.
• Travel as necessary to other facilities.
• Performs other duties as assigned.

• Verify patient insurance coverage and update system accordingly to ensure a clean billing process.
• Prioritize incoming authorization requests according to urgency.
• Generate, verify, and oversee the complete procedure authorization/referral process.
• Obtain authorization by fax, payer website or by phone and follow up regularly on pending cases.
• Notify appropriate departments for approvals and denials.
• Initiate and assist with appeals for denied authorizations.
• Monitor provider network status and notify appropriate individuals of non-network status providers.
• Notify and coordinate peer-to-peer (P2P) requests with the appropriate department.
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Contact patients as needed to discuss authorization status
• Manages and resolves day-to-day issues pertaining to pre-authorization, as needed.
• Maintain, monitor, and update payer medical policy guidelines to manage authorization requirements.
• Requests, reviews, and submits necessary patient documentation as needed.
• Schedule and organize patient appointments and/or procedures according to physician and patient availability within the designated network.
• Utilizes ICD 10, CPT, HPCPS, modifiers and/or other codes according to coding guidelines.
• Communicates effectively with provider and/or all appropriate parties regarding missing information such as CPT, diagnoses codes, documents, operative reports, etc. to ensure proper authorization processing.
• Communicates effectively with other departments regarding changes and/or updates with patient accounts and status.
• Responds to billing inquiries.

• Strong organizational skills.
• Ability to handle stressful situations in a professional manner.
• Strong communication skills.
• Ability to model corporate values.
• Has a “can do” attitude.
• Strong attention to detail: being careful about detail and thorough in completing work tasks.
• Ability to work independently by guiding oneself with little or no supervision and depending one oneself to get things done.
• Ability to maintain records.
• Exceptional customer service and phone etiquette.
• Strong computer skills with proficiency in Microsoft Office, including Outlook, Excel, Word & eCW (EMR).

• High School Diploma or GED
• One (1) year in a medical office setting

BENEFITS OFFERED:

• 3 Medical Plans
• 2 Dental Plans
• 1 Vision Plan
• Employee Assistance Program
• Short and Long-Term Disability Insurance
• Basic and Voluntary Life with AD&D Plan
• 401(k) with a 2-year vesting
• PTO Holidays

Please visit our website for more information:

minivasivepain.com