Workers Compensation Authorization Specialist

About the Company

CitiMed is a unique medical facility that provides exclusive healthcare amenities to our community. The range of medical and rehabilitative services offered has been specifically selected to treat traumatic injury patients. We provide a variety of health services including diagnostic and rehabilitation. Our vision directs the evolution of our practice, as we strive to improve our services to the community. All CitiMed offices are multilingual and staffed with individuals to make any experience pleasant. You can learn more about us at https://www.citimedny.com/. CitiMed is growing rapidly and we are looking for many qualifying individuals to be a part of our team! With the support and hard work of all our employees, CitiMed continues to make its way down a successful road. CitiMed maintains a work culture that allows our team members to feel supported and confident in their work. We offer many learning opportunities with room for professional growth. If the responsibilities interest you and believe you have met the requirements, we strongly encourage you to apply!

About the Role

CitiMed is seeking an ambitious, relationship-driven, and process minded Workers Compensation Authorization Specialist. Your primary responsibility will be to review and adjudicate the worker’s compensation authorization denials in an efficient and accurate manner. The ideal candidate is a proactive, self-starting, analytical and enthusiastic leader who is proactive and has the ability to critically think through denial situations. This candidate will be a problem solver and the ability to think quickly and accurately will determine the success of the candidate. We are looking for a resourceful, bright, proactive leader who works well independently and as part of a team in an ambiguous environment across time zones. Reporting to the Surgical Coordinating Lead, this position will be a key leader in the success of CitiMed’s future.

Responsibilities

• Review Authorization Workers Compensation denials by identifying the type of denials for burden of proof or medical criteria not met.
• Once denial rationale is identified, reach out to the appropriate party (Attorney's office, WCB, Practice Locations, etc.) and obtain necessary information.
• Coordinate with the treating facilities for patients to be seen by the providers to meet the demands of the carrier/board's decision-making.
• Contact the attorney’s office via emails or phone calls on any items that need action such as controverted cases, cases under appeals, litigation, disallowed, or carrier undetermined. Also connect with the attorney's office if the patient needs a hearing to get a body part formally established. Submit RFA's as necessary.
• Download and upload any required medical records that are requested by the attorney's office pertaining to establishing body parts.
• Coordinate with Practice Locations and Providers on proper documentation requirements. If needed, provide education on required medical documentation to support any amendments pending.

Required Skills

• Minimum 2 years of experience in workers' compensation authorizations, denials management, medical billing/claims, or a related healthcare administrative role.
• Extremely detailed oriented, excellent problem-solving skills, and the ability to think critically. The ability to quickly think and make accurate decisions will determine the success of the candidate in this role.
• Strong communication skills with the ability to diagnose the cadence of any conversation.
• Ability to communicate effectively with a variety of personalities to achieve required results.
• Ability to handle large volume of work and produce results in an accurate and efficient manner.

Pay range and compensation package

Hourly Rate/ Salary depends on experience.

Equal Opportunity Statement

CitiMed is committed to diversity and inclusivity in the workplace.