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Workers Compensation Specialist
2 months ago
DESCRIPTION
JOB SUMMARY: Responsible for transitional phases of the workers compensation program within the office. Beginning with the verification of coverage on each workers compensation patient and the filing of all required DWC (Division of Workers Compensation) patient status forms, to the necessary updates with insurance companies and case managers.
RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:
Receives referrals from outside sources for new patients. Verifies coverage and treatment designated with insurance adjusters prior to appointment and schedules initial appointment.
Reviews and provides status of treatment to insurance adjusters and case managers when requested. Remains in close contact with patients during entire course of treatment.
Monitors changes in the rules of the Division of Workers Compensation
Updates key personnel regarding changes in requirements of the DWC
Coordinate with AOA business office to evaluate and resolve reimbursement issues
Maintain patient files in the EMR system, ensuring accuracy of all information related to Workers Compensation cases
Complete and submit DWC required reports in accordance with approved DWC regulations
Solves difficult problems involving Workers Compensation patients, whether relating to work status or claim problems
Maintains a working knowledge and complies with all established policies and procedures of the DWC
Must understand a PLN11 and PLN1
Must be able to communicate with doctors and their clinical teams
Responds to patient/adjustor/insurance questions in a timely manner
Attends required staff meetings
Maintains patient confidentiality
Knowledge of surgery/testing preauthorization process
Additional responsibilities as assigned by manager
REQUIREMENTS
EDUCATIONAL REQUIREMENTS:
High School Diploma/GED or equivalent experience
QUALIFICATIONS AND EXPERIENCE:
1-2 years Work Comp Experience with physician clinic setting preferred
Knowledge of the Division of Workers Compensation (DWC) rules and regulations
Experience in filing required DWC reports with employees, insurance companies, and the DWC
Background in medical terminology, preferably orthopedics
Working knowledge of AOAs practice management system
Knowledge of CPT and ICD-10 coding for the specialty
Pleasant speaking voice and demeanor
Experience in a project-oriented position preferred
Neat, professional appearance
Strong written and verbal communication skills
Company: AOA Orthopedic Specialists
Job Type: Full-time
Address: 800 Orthopedic Way, Arlington, TX, 76105
