JOB SUMMARY:
Under the direction of the Occupational Health Manager, functions as a liaison between patient (injured worker), patient’s employer, case manager, physicians (and staff) and insurance carriers in regards to Workers’ Compensation related questions and issues. Has knowledge of compliance and regulatory issues related to Workers’ Compensation, providing effective case management services, ensuring the highest level of communication and excellent customer service to all parties.
SCHEDULE:
Opportunity for 1 remote day per week, after 6 months (in good standing)
8:30 - 5
Monday - Thursday
8- 4:30
Friday
No weekends, holidays, nights
TRAVEL:
Occasional travel to remote sites:
Hanover, Mechanicsburg, Enola
QUALIFICATIONS AND EDUCATION:
Education:
High School diploma or equivalent required.
Associate degree in related field or equivalent level of experience strongly preferred.
MA or LPN Required
Qualifications:
General computer software knowledge required.
Excellent organization, problem-solving and communication skills required.
Excellent analytical and customer service skills to facilitate the resolution of case management problems.
Effective organizational and planning skills
Effective written and verbal communication skills
At least one year of Workers’ Compensation or related experience required.
Basic knowledge of the needs of the employer and insurer.
Basic knowledge and understanding of medical terminology.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Facilitates case management for injured workers currently being treated by OSS Health.
Receives claim, confirms policy coverage and acknowledgment of the claim.
Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case (Employers, NCM) necessary for case management of the injured worker/disabled individual. Including facilitating communication with companies in the area to promote OSS as a panel provider for work related injuries. Maintain panel of WC companies.
Handles claims consistent with client's policies/panels, procedures and "best practices" and in accordance with any statutory, regulatory and ethics requirements.
Facilitate timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured workers, employer, insurer, and physicians.
Obtains out-of-state authorizations for treatment prior to appointments.
Maintain up to date and accurate documentation and records on claims.
Communicates with AR department regarding denials and changes within accounts for WC patients.
Ensuring confidentiality and professionalism is maintained when dealing with sensitive and confidential information.
Returns voicemail, email, and any other inquiries in a timely manner.
Partners with and supports other departments that work with and in conjunction with the Workers Compensation Department
Exercises sound, independent judgment in decision-making.
Render opinions regarding treatment plan, outcome, and problem areas, and makes recommendations to facilitate case management goals to include RTW.
Identify opportunities for cost control, process improvements and quality improvements related to customer service.
Report findings and concerns to Senior Management along with timely and logical recommendations on how to improve unfavorable situations or complaints and how to reduce or avoid unfavorable conditions.
Other duties as assigned.
SUPERVISORY RESPONSIBILTIES:
No direct reports to this position.
LANGUAGE SKILLS:
Ability to communicate effectively, in English, with staff, peers, physicians and the public both verbally and in writing.
PHYSICAL DEMANDS:
Work generally performed in an office setting during standard day shift hours. The noise level is typically moderate. Work may occasionally be fast paced and require dealing with multiple priorities and time constraints. Work requires some physical activity with periods of prolonged sitting. Incumbents must have the ability to transport self to and from various locations throughout the department and office locations. Must be able to operate computers and other equipment used to perform this job's essential functions. Light physical effort required; some standing, walking, bending, reaching, and stooping. Able to maintain a pleasant and courteous demeanor under all circumstances.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT:
Climate controlled environment with occasional periods of being outside.
The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
Experience
Preferred
Basic knowledge of the needs of the employer and insurer.
At least one year of Workers’ Compensation or related experience required.