Workers Compensation Specialist

 Job Title: Professional Reimbursement Specialist - Workers Compensation Key Responsibilities: 

• Manage workers compensation incoming calls, faxes, emails and referrals
• Communicate effectively with adjusters, nurse case managers, referral sources, and physicians by obtaining or providing requested workers comp information on new or existing patients  
• Assists other departments and physician teams by providing or verifying workers comp information when needed
• Responding to and documenting patient cases to ensure proper processing and scheduling  
• Submit treatment orders to utilization review companies for approval and follow up to ensure complete authorization process  
• Schedule patient appointments and workers comp appointed exams
• Maintain knowledge and education to be effective and productive on prior authorization requirements 
• Work with individual department co-workers on special projects as requested by supervisor 
• Follow the requests and directions of department Lead, Manager, Director, and physicians  
• May be required to assist other areas in referrals/authorizations department when staffing is needed 
• Participate in monthly and quarterly meetings within respective department and team to discuss policies, protocols, and best-practices
•  Adhere to applicable healthcare laws, regulations, and orthopaedic practice policies and procedures, including requirements related to patient privacy, documentation, billing, and ethical conduct. Protects patient confidentiality, completes required compliance training, and promptly reports suspected compliance or ethical concerns.
• Comply with healthcare regulations and orthopaedic practice policies and procedures; ensures accurate documentation and ethical conduct; protects patient confidentiality; completes required compliance training; and reports compliance concerns in a timely manner.
• Comply with healthcare regulations and practice policies and procedures; protects patient confidentiality; and reports compliance or ethical concerns in a timely manner.

We offer a competitive salary and benefits package, along with opportunities for professional growth and development. If you are a motivated individual with a passion for reimbursement processes, we encourage you to apply.

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  Skills and Qualifications:

• Must have a High School Diploma or equivalent.  
• Required knowledge of self-insured and network Workers Compensation programs, rules and regulations.  
• Proficient computer skills. Exceptional customer service skills. Proficient and accurate data entry skills. Proficient with Microsoft programs (Excel, Word, etc.)
• Ability to communicate effectively. Excellent research, follow-through and documentation are required. 
• Prolonged sitting. Repetitive motion (data entry), and phone contact. 
• Ability to multi-task, prioritize work and make sound judgements.  
• Other duties as assigned as necessary and may vary at times, as needed, by your immediate supervisor or as directed by the company. 
•  Requires predictable and consistent attendance