What are the responsibilities and job description for the Workers' Compensation Specialist position at Rockhill Orthopaedic, PC?
Rockhill Orthopedics
Position Summary - Workers' Compensation Specialist is a full-time position responsible for managing all aspects of workers’ compensation claims submitted to Rockhill by injured employees, including verifying eligibility, reviewing medical documentation, communicating with insurance carriers, scheduling necessary appointments, and ensuring timely and accurate billing for treatment provided, all while adhering to Missouri and Kansas regulations and company policies. The ideal candidate will have excellent organizational and prioritization skills, be able to work collaboratively in a team environment, and have a strong commitment to delivering high-quality results.
Key responsibilities may include:
Claim intake and Verification:
- Receive and review workers’ compensation claim forms from patients.
- Verify employment status and eligibility for coverage with the employer/insurance carrier.
- Obtain necessary documentation including accident reports and medical records.
- Receive and process requests from adjusters and paralegals for independent medical exams, depositions and ratings.
Medical Document Review:
- Analyze medical records to assess nature of the injury and treatment plan.
- Ensure medical documentation supports the diagnosis and treatment provided.
- Communicate with treating physicians to clarify any questions regarding medical necessity.
Insurance Carrier Communication:
- Contact insurance carriers to notify them of new claims and provide updates on treatment progress.
- Obtain pre-authorization for necessary procedures when required.
- Address any claim denials or disputes with insurance carriers.
Patient Coordination:
- Schedule appointments for injured workers based on their treatment plan.
- Educate patients about the workers’ compensation process and their responsibilities.
- Monitor patient progress and communicate any concerns to the treating physician and insurance carrier.
Billing and Coding:
- Accurately code and submit invoices to insurance carriers and law firms following billing guidelines.
- Follow up on Accounts Payable/ Receivable for all legal services rendered.
Required skills and Qualifications:
- Strong understanding of workers’ compensation laws and regulations.
- Excellent communication and interpersonal skills to interact with patients, physicians, insurance carriers and law offices.
- Detail-oriented with the ability to manage multiple tasks efficiently.
- Familiarity with EPIC, electronic health records (EHR) systems preferred.
- Bachelor’s Degree or healthcare administration related degree preferred, with 1-3 years of workers compensation experience. Minimum High School diploma or equivalent required. Desirable experience a med-only insurance adjuster or paralegal.
