Paralegal - Workers Compensation Specialist

3 weeks ago

Middletown, Connecticut, United States Spire Orthopedic Partners Full time
Job Details

Job Category: Health Care

Position Type: Full Time

Education Level: High School or Equivalent

Travel Percentage: Some travel between company locations

Job Shift: Day

Job Description

Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital, and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most - patient care.

Middlesex Orthopedic & Spine Associates is seeking a full-time Worker's Comp/No Fault Coordinator to join our team in Middletown, CT. We are a growing practice with ample opportunity for career growth. Competitive salary and benefits. Thrive as a valued member of this growing team, where we are committed to excellence across all aspects of our organization.

Responsibilities
  1. Main point of contact for all patients regarding worker's compensation, auto accident, or no-fault injury cases.
  2. Contacting patient employers for Worker's Compensation case information and claim details.
  3. Obtaining, verifying, and documenting all worker's compensation, auto accident, and no-fault claim and insurance information, including commercial insurance payers.
  4. Daily phone, fax, and email communication with insurance companies and attorneys regarding claims.
  5. Contacting adjuster or legal representative/attorney for case information, to include client information, and schedule appointments as necessary.
  6. Maintains spreadsheet tracking of new patient referrals.
  7. Obtaining timely insurer authorizations related to proposed treatment plans.
  8. Prepare and send Fee Schedules for prepayments of IMEs and 2nd opinion exams, Medical Record Reviews, and Final Ratings - tracks on the internal department spreadsheet.
  9. Receives and processes medical records and other pertinent documents for the above services and provides to the Physician in a timely manner.
  10. Schedules IME's, RME's, Medical Record Reviews, Final Ratings, depositions, attorney-physician calls and/or meetings.
  11. Maintains Physician calendars for Depositions, IME's, MRR, and Final Ratings.
  12. Works with Transcription, Physician, adjusters, law offices, and vendors to ensure all Physician letters and/or reports are completed and returned in a timely manner.
  13. Follow-up with case managers, adjustors or attorney offices regarding payment needed for Fee Schedules previously sent, outstanding balances.
  14. Liaison between the physician and insurance carrier, legal representative/attorney.
  15. Perform continual follow-up with adjusters and/or case managers on claim status.
  16. Coordinates with law offices, and legal representative/attorneys to obtain Letters of Protection as appropriate.
  17. Posts all pre-payments to the patient ledger, scans a copy of payment to the patient chart.
  18. Request status updates, and periodic reviews on litigated claims.
  19. Contacts Attorney's office to ensure the case is still current.
  20. Assists Admin and Surgical Scheduling staff with authorizations for procedures and surgeries, provides fee schedules for proposed procedures and surgeries.
  21. Attends and/or assists with worker's compensation hearings.
  22. Documents and communicates all claim activity in a timely manner.
  23. Responds to emails (internal and external), voicemails, EMR tasks, fax communication, department mail.
  24. Answers and triages department phone calls (internal and external); responds to patients, law offices/attorneys, and outside referral agencies promptly.
  25. Verifies and documents approvals and faxes, and routes information as appropriate.
  26. Coordinating and developing relationships with multiple Worker's Compensation carriers, adjusters, law offices/attorneys, vendors, and referring providers.
  27. Negotiates and approves settlements/reductions within the prescribed limit as directed by VP of Operations.
  28. Communicates billing changes and/or policies to law offices/attorneys and patients.
  29. Provides billing statements to law offices/attorneys as requested.
  30. Works with Billing Liaison and Supervisor to update billing claims.
  31. Performs all other tasks and projects assigned by Supervisor or VP of Operations.
  32. Works closely with Supervisor on department issues, outside complaints, and workflow.
Qualifications
  • High School Diploma or equivalent required.
  • Medical office experience preferred.
  • Paralegal experience required to include knowledge of Letters of Protection, Final Ratings, WC hearings, and No-Fault claims.
  • Ability to use computerized systems.
  • Must be detail-oriented and accurate.
  • Time Management and Multi-tasking skills.
  • Ability to work well under pressure.
  • Strong interpersonal and customer service skills.
  • Knowledge of different insurance carriers and plan types.
What We Offer
  • Excellent growth and advancement opportunities.
  • Dynamic environment.
  • Access to a diverse network of practitioners.
  • Broad infrastructure of tools and programs to enhance the employee experience.
  • Competitive Compensation.
  • Generous PTO.
  • Benefits package: health, dental, vision, 401(k), etc.

We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as 'protected characteristics').

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