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Workers' Compensation Payor Specialist
3 months ago
If you're looking for a place to call home and grow, Three Crosses Regional Hospital is looking for you We are looking for Workers’ Compensation Payor Specialist that is committed to clinical excellence and building a patient-centered culture.
Three Crosses Regional Hospital is an advanced independent healthcare organization led by a local team of professionals dedicated to high quality patient care and being the first choice of patients and providers in the communities we serve.
We are dedicated to hiring team members that will adapt to our culture, pride themselves in professionalism, integrity, transparency, two-way communication, and ensuring the safety and well-being of our patients and staff.
The Workers’ Compensation Specialist is responsible for transitional phases of the worker’s compensation program within the medical office. Beginning with gathering information and intake information from the patient, verification of coverage on each worker’s compensation patient and the filing of all required patient status forms, to the necessary updates with insurance companies and case managers.
The incumbent will carry-out her/his duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of Three Crosses Regional Hospital, and fully supports the mission, vision, and values of Three Crosses Regional Hospital. The incumbent will have knowledge of health care systems, and have demonstrated ability to interact, relate to, work with, and support the activities of a diverse workforce.
Primary Responsibilities
- Responsible for all patient in-take, IME’s, second opinions, impairment ratings, activities involving Workers’ Compensation.
- Gathers necessary patient information regarding injury/claim, schedule appointments and accurately complete intake documentation, assemble patient files, coordinate with workers’ compensation Insurer and or case manager on validity, coverage, authorization, no shows, appointment scheduled etc.
- Prepare new patient charts and update patient demographics and provide patient documentation to the treating provider.
- Coordinate location of IME, second opinion and impairment ratings based on provider schedule and location of patient.
- Ensures all medical records are reviewed by provider prior to appointment and that record review is dictated and medical records are placed in chart according to provider preference prior to appointment.
- Call referring medical office for Medical Records and appointment notification in advance of all scheduled appointments and ensure medical records received are part of the patient’s chart for provider review.
- Assures compliance with regulatory standards applicable to Workers’ Compensation claims.
- Effectively manage all incoming and outgoing communications involving patients with Workers’ Compensation claims.
- Answers incoming calls and check and return voice mail messages within the day received.
- Check and return email correspondence within the same day received.
- Check and respond to faxes within the day received.
- Maintain strict compliance with all confidentiality requirements including but not limited to HIPAA and those established by the organization and medical office.
- Assists Medical Assistants with Workers’ Compensation progress notes to Case Managers/Adjusters upon request.
- Assists at the front desk, answering incoming calls, schedule and cancel appointments, verify insurance, sort incoming mail etc.
- Attend staff meetings as needed.
- Other duties as assigned.
- Required: High School Diploma or equivalent
- Required: 1 year experience in a customer service and medical office setting environment in an administrative/secretarial, appointment scheduling position.
- Preferred: Knowledge of the Division of Workers’ Compensation (DWC) rules and regulations
- Preferred: Medical Assistant or related field.
- Required: Meet all Employee Health Requirement
