Occupational Health Services Coordinator

Summary

The Occupational Health Services Coordinator plays a pivotal role in supporting the delivery of high-quality occupational health services across multiple states. This position handles coordinating medical referrals, managing authorizations, scheduling diagnostic services, and ensuring compliance with state-specific workers' compensation regulations and industry standards. The coordinator serves as the primary point of contact for communication with healthcare providers, insurance carriers, employers, and patients, helping seamless operations and enhancing patient care. This role requires great attention to detail, excellent organizational skills, and the ability to navigate complex healthcare systems. The ideal candidate will have a solid understanding of occupational health practices, including workers' compensation laws, HIPAA compliance, and OSHA standards, and be committed to supporting the highest standards of patient care and regulatory compliance. This entry-to-mid-level position offers opportunities for professional growth and advancement within the organization.

Key Responsibilities

Referral & Authorization Coordination

• Coordinates referrals to specialists for work-related injuries or illnesses, ensuring prompt appointments and follow-up care, prioritizing urgent cases such as STAT referrals.
• Requests and tracks authorizations for treatments, including physical therapy, chiropractic care, massage therapy, and other prescribed services, adhering to insurance carrier requirements and timelines.
• Expedite STAT referrals and appointments for urgent cases, communicating directly with providers and insurance carriers to fast-track approvals.
• Maintains comprehensive logs of all referrals and authorizations, including dates, providers, and status updates, to ensure accountability and audit readiness.
• Collaborate with clinic providers to obtain detailed treatment plans and medical justifications for referrals and authorizations, ensuring complete and correct documentation.
• Adheres to insurance carrier and employer requirements for pre-authorizations, particularly for high-cost treatments like MRIs or surgeries, to prevent claim denials.
  
  

Diagnostic & Billing Support

• Schedule diagnostic services, such as scans, MRIs, and offsite X-rays, for patients with work-related injuries, coordinating with external providers for prompt appointments.
• Collect patient demographics, insurance information, and other details to ease smooth billing processes.
• Collaborate with the billing and claims department, working with insurance carriers to resolve discrepancies or delays in payment, including supporting appeals for denied claims.
  
  

Documentation & Compliance

• Email or fax necessary forms and dictations to insurance companies or employers.
• Ensure healthcare providers sign off on required paperwork on time.
• Respond to medical records requests from insurers, employers, or other authorized entities.
• Ensure all patient documentation, including medical records, treatment notes, and correspondence, is correct and compliant with HIPAA regulations and company policies.
• Review and verify the completeness and accuracy of documentation before submission to workers' compensation adjusters and insurance carriers.
• Stay current with state-specific workers' compensation regulations across states where the business operates.
• Coordinates preparing and submitting necessary reports and documentation to regulatory bodies, ensuring timely and accurate compliance. This includes submissions for injury, illness records and record keeping.
  
  

Insurance & Claims Coordination

• Contact insurance carriers for Joint Services Agreement and Functional Capacity Work authorizations, providing all necessary documentation.
• Gather and verify claim information, including policy details, coverage limits, and pre-existing conditions, to ensure right claim processing.
• Help with preparing and sending claim forms, such as the First Report of Injury, ensuring all information is complete to prevent delays or denials.
• Monitor claim statuses and follow up with insurers on pending authorizations, payments, or disputes, advocating for patients and employers as needed.
• Collaborate with case managers and adjusters to ensure treatment plans align with insurance coverage and medical necessity, including understanding utilization review processes.
• Aid in navigating workers' compensation claims, ensuring accurate and timely submission of documentation.
  
  

Communication & Customer Service

• Serve as the primary point of contact for medical providers, insurance representatives, employer contacts, and patients, providing timely and accurate information on referral and authorization statuses, treatment plans, and work restrictions.
• Address direct inquiries and concerns, troubleshooting issues related to scheduling, billing, or claims processing, and escalating complex matters to appropriate personnel.
• Maintain a professional and courteous demeanor in all interactions, ensuring clear and respectful communication.
• Document all communications in the electronic medical records system for reference and compliance purposes.
• Proactively communicate updates and changes in patient statuses, treatment plans, or insurance requirements to relevant parties.
• Foster positive relationships with external partners, such as specialists, diagnostic centers, and insurance carriers, to improve service delivery.
• Perform other duties as assigned.
  
  

Required Skills & Qualifications

• Education & Experience: High school diploma or equivalent (required); Associate degree or higher in healthcare administration, medical billing, or related field (preferred).
• Experience: 1-3 years of experience in healthcare administration, medical office support, insurance coordination, workers’ compensation, or customer service is a plus.
• Certifications: Certifications such as Certified Case Manager are beneficial but not needed.
• Technical Skills: Ability with Systoc electronic medical records system and familiarity with Microsoft Office Suite (Word, Excel, Outlook).
• Other Requirements: Ability to obtain and keep any necessary licenses or certifications as required by state regulations.
  
  

Key Competencies

• Attention to Detail: Ability to manage multiple tasks with high accuracy and thoroughness.
• Customer Service Orientation: Professional, courteous, and able to resolve issues efficiently, ensuring stakeholder satisfaction.
• Follow-Through: Ensures tasks are completed accurately and on time with a proactive approach.
• Communication Skills: Excellent written and verbal communication, conveying complex information clearly and professionally.
• Problem-Solving Abilities: Identifies issues and proactively seeks solutions, demonstrating critical thinking.
• Technical Proficiency: Comfortable with Systoc electronic medical records systems, Microsoft Office, and other relevant software; quick to learn new technologies.
• Compliance Knowledge: Familiarity with HIPAA regulations, state-specific workers' compensation laws, and OSHA standards.
• Organizational Skills: Strong ability to prioritize tasks, manage time effectively, and keep organized records.
• People Skills: Builds and supports positive relationships with colleagues, providers, and external partners.
• Adaptability: Flexible and able to adapt to changing priorities and work environments, including potential remote or hybrid setups.
  
  

Work Environment & Schedule

• Work Setting: Initially office-based, transitioning to hybrid or offsite depending on organizational needs. The role requires regular interaction with clinic staff, patients, employers, and insurance representatives via phone, email, and video conferencing.
• Schedule: Full-time position (40 hours per week) with standard business hours. Occasional overtime may be required to meet business needs, particularly during peak periods or urgent referrals.
• Travel: Minimal travel may be needed for meetings or training sessions, with most work performed remotely or from the office.