What are the responsibilities and job description for the Worker's Comp and Personal Injury Coordinator- Tinley Park position at Primus Ortho?
Answering phone calls directed to you by the auto attendant or front desk, checking and returning voicemails.
Clinic Prep and Follow Up for all WMC/PI patients (obtain authorizations, complete circle of care, etc.)
Ensuring we have complete insurance and attorney information on new patients that have been scheduled
Entering any past patient's insurance and attorney info as it comes in.
Obtain Authorizations for PT treatment
Preparing liens for PI cases at the onset of any treatment that is rendered.
Constant e-mail monitoring and correspondence.
Making patient appointments, mostly new patients coming from strong referral sources. (Most appointments are made by the front desk, but sometimes they come directly to you.)
Appealing any denied authorizations, and collecting information from the doctor, etc. in order to appeal. Working any denials received on WMC patients (determining reason for denial, gathering evidence to appeal denial, calling insurance companies to discuss denials, etc.)
Facilitating any requested Peer to Peer discussions between the requesting party and the doctor.
Send Itemized bills in response to medical records requests
Any other duties and/or special projects as assigned by supervisors or management.
Reviewing the schedule for the following day. ● Make sure all information for WMC (Accepted Workers' Comp), PI (Personal Injury), LWC (Litigated, Non- Accepted WMC) & DOL (Department of Labor) patients are correct. ● If any insurance info is missing, make calls to determine: o Case Status (Open/Accepted) o Accepted Body Part o Adjuster & NCM Contact Info o Where to send authorization requests (may have a Utilization Review Dept) o Billing Address o Any attorney information if applicable. ● Print most up to date FCS.
Clinic Follow Up Duties
Expectations ● This position is very detailed, and involved. ● It requires you to stay organized and make sure that you can retrace your steps at any time. ● It requires a significant amount of patient interaction, keeping them updated on the status of their authorizations, what to expect, explaining the system, explaining our procedures, etc. ● It requires significant relationship building, keeping on top of requests from referring doctors/facilities. We want to make things as easy as possible for them, so that they continue to refer patients to our office. ● It requires outstanding communication on all fronts, you are our quarterback for these patients, you coordinate and communicate between; the doctor, adjuster, nurse case managers, attorneys, referring doctors, physical therapists, and our team at the office. ● It is expected that the WMC Specialist should keep a task list, to make sure that everything is taken care of by set deadlines. ● If the response needs more follow up, you are expected to respond to the e-mail or voicemail, to let them know when to expect an answer. ● You are expected to be patient, courteous and professional at all times, remembering that you have a direct impact on the success of the practice.
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