What are the responsibilities and job description for the Workers Compensation Specialist position at Tri-State Orthopaedic Surgeons?
Workers' Compensation Specialist
Job Summary:
Under the direction of the Work Comp Coordinator, this employee is responsible for the coordination of services required by patients, their employers, and case management organizations to create a streamlined approach for Work Comp Healthcare. Regular attendance is an essential part of this job.
Essential Functions:
Job Summary:
Under the direction of the Work Comp Coordinator, this employee is responsible for the coordination of services required by patients, their employers, and case management organizations to create a streamlined approach for Work Comp Healthcare. Regular attendance is an essential part of this job.
Essential Functions:
- Prints Pre-cert forms from computer
- Prints all work comp policy forms
- Schedules all work comp appointments
- Pre-certs any diagnostic tests, surgeries, consults, referrals to another physician
- Schedules Functional Capacity Exams (FCEs) at Tri-State Orthopaedics
- Handles internal work comp claims
- Faxes all therapy (work comp) notes
- Faxes all work comp dictations and work status updates
- Dictates letters for physicians
- Schedules and tracks Independent Medical Evaluation (IME) records and prepays (x-rays)
- Sort faxes from Scan place
- Handles voicemails/email messages
- Answers questions/concerns for insurance companies, case managers, and employees
- Some billing/coding responsibilities
- Speaks with disgruntled patients in person or via phone
- Explains PPI and/or Maximum Medical Improvement (MMI) to patients
- Verifies work comp injury
- Works claim denials
- Helps facilitate solutions to problems
- Schedules and attends external site visits with employers and physicians
- Meets with employers/insurance, case managers
- Build and maintain strong business relationships with key accounts
- Meets with doctors
- Reschedules appointments for patients and notifies patient, case manager, and employer insurance when office cancelled or changed
- Retrieves reports
- Scans work comp paperwork, double check to see that all paperwork made it to the chart
- Calls dates and times for scheduled procedures
- Enters employer insurance and all appropriate notes with contact information
- Gains expertise and knowledge to anticipate and effectively manage work comp growth opportunities
- Covers other associates when needed
- Promotes Tri-State Orthopaedics workers compensation services
- Attends seminars/conferences to stay current on work comp practices
- The preceding examples are representative of the assignments performed by this position and are not intended to be all-inclusive.
- Prior experience in the medical field preferred.
- Prior case management experience managing work comp cases preferred
- Familiarity with Indiana Work Comp laws preferred
- Strong verbal, written, interpersonal skills
- Strong problem-solving skills
- Basic computer skills
- Excellent time management and organizational skills
- Ability to work collaboratively with a multi-functional team including all doctors, nurses, case managers and employers in a professional manner
