Workers Compensation Specialist

3 weeks ago

Carrollton, United States Resurgens Orthopaedics Full time

Job Type

Full-time

Description

Job Summary: We are seeking an experienced Workers' Compensation Specialist to work in OrthoTexas's central Business Office in Carrollton. The Workers' Compensation Specialist is the liaison between the patient, insurance carrier, and physician and works in a fast-paced position.

Key Functions:

  • Obtains complete and accurate patient and injury information before scheduling appointments. Creates and maintains a Medical Chart on all workers comp patients.
  • Verifies work related injury information with proper employer personnel.
  • Verifies eligibility of injury and insurance benefits with insurance carrier representative.
  • Translates between provider and patient as needed.
  • Obtains correct insurance carrier billing address and claim number if assigned.
  • Ensures proper documentation is attached to billing claims before submission or re- submission of the claims.
  • Enters complete and accurate demographics into the billing system to ensure proper billing before the patient's first visit.
  • Obtains pre-certifications and authorizations for treatment on a daily basis.
  • Ensures completion of all TWCC required forms.
  • Performs various collection activities to ensure payment is received and posted for each account. Contacts carriers, patients, or employers as needed to obtain/provide account information.
  • Interprets appointment request and schedules patient appointment based on clinic policies. Identifies any problems with making the appointment and advises Physician and/or Manager.
  • Checks answering service & reminder call email each morning for patient messages.
  • Obtains patient's demographic information, insurance policy and medical issue.
  • Informs patient about new patient and payment policies & referrals.
  • Verifies insurance for same day add-on appointments.
  • Relays relevant information to the Clinic Front Desk, Medical Records and appropriate internal staff when adding or changing an appointment.
  • Provides any special needs of the patient to the Physician.
  • Answers telephone, screens calls, takes messages, transfers calls to the appropriate area and provides information to keep the patient and clinic staff fully advised regarding appointments scheduled.
  • Answers questions regarding patient appointments as requested.
  • Makes necessary patient and/or policyholder information corrections in the Appointment System as necessary and advises the Patient and Billing.
  • Safeguards patient information and ensures all information remains confidential.
  • Request assistance from the Biller or Collectors for difficult account billing questions.
  • Participates in office meetings and educational activities.
  • Maintains work area in neat and orderly manner.
Requirements
  • High School Diploma or GED, required.
  • Bilingual Preferred.
  • Graduate of accredited program in Medical Administration, preferred.
  • Knowledge of TWCC rulings and forms, strongly preferred.
  • Ability to read, understand and master policies and regulations.
  • Ability to use patient management systems and computer software (e.g., patient billing & collecting system, electronic medical record system, word processing).
  • Ability to interact and communicate well with patients, staff, and vendors.

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