Paralegal - Workers Compensation Coordinator

6 days ago

Middletown, Connecticut, United States Spire Orthopedic Partners Full time
Job Title: Paralegal - Workers Compensation Coordinator

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.

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.

The Spire network spans the Northeast with more than 165 physicians, 1,800 employees, 285 other clinical providers, and 40 locations in New York, Connecticut, Rhode Island, and Massachusetts.

This position plays a key role in the efficient and effective clinical and financial operations of the practice.

Key Responsibilities:
  • Contact patient employers for Worker's Compensation case information and claim details
  • Obtain, verify, and document all worker's compensation, auto accident, and no-fault claim and insurance information, including commercial insurance payers
  • Daily phone, fax, and email communication with insurance companies and attorneys regarding claims
  • Contact adjuster or legal representative/attorney for case information, to include client information, and schedule appointments as necessary
  • 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
  • Receives and processes medical records and other pertinent documents for the above services and provides to the Physician in a timely manner
  • Schedules IME's, RME's, Medical Record Reviews, Final Ratings, depositions, attorney-physician calls and/or meetings
  • 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
  • Liaison between the physician and insurance carrier, legal representative/attorney
  • Perform continual follow-up with adjusters and/or case managers on claim status
  • Coordinates with law offices, and legal representative/attorneys to obtain Letters of Protection as appropriate
  • Posts all pre-payments to the patient ledger, scans a copy of payment to the patient chart
  • Request status updates, and periodic reviews on litigated claims
  • Contacts Attorney's office to ensure the case is still current
  • Assists Admin and Surgical Scheduling staff with authorizations for procedures and surgeries, provides fee schedules for proposed procedures and surgeries
  • Documents and communicates all claim activity in a timely manner
  • Answers and triages department phone calls (internal and external); responds to patients, law offices/attorneys, and outside referral agencies promptly
  • Verifies and documents approvals and faxes, and routes information as appropriate
  • Coordinating and developing relationships with multiple Worker's Compensation carriers, adjusters, law offices/attorneys, vendors, and referring providers
  • Negotiates and approves settlements/reductions within the prescribed limit as directed by VP of Operations
  • Communicates billing changes and/or policies to law offices/attorneys and patients
  • Provides billing statements to law offices/attorneys as requested
  • Works with Billing Liaison and Supervisor to update billing claims
  • Performs all other tasks and projects assigned by Supervisor or VP of Operations
  • Works closely with Supervisor on department issues, outside complaints, and workflow

Medical office experience preferred. Paralegal experience required to include knowledge of Letters of Protection, Final Ratings, WC hearings, and No-Fault claims.

Excellent growth and advancement opportunities. Access to a diverse network of practitioners.

Benefits:

Health, dental, vision, 401(k), etc.

Spire Orthopedic Partners is an equal opportunity employer and welcomes applications from diverse candidates.

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