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Workers Compensation Specialist

3 months ago

Fort Worth, United States Resurgens Orthopaedics Full time

Job Type

Full-time

Description

JOB SUMMARY: Responsible for transitional phases of the worker's compensation program within the office. Beginning with the verification of coverage on each worker's 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 Worker's 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 AOA's 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