Workers' Comp Coordinator Full-Time AVALA Hospital RH422

Summary

The Workers Comp. Coordinator performs a variety of tasks as the first point of contact by the patient/nurse case manager with the clinic. This individual is responsible for coordinating all scheduling requests answering questions responding to emails and incoming referrals coordinating all medical records/imaging and communicating the plan of care following the patient encounter. The individual must work collaboratively with many team members to provide seamless support to the organization. This position also completes data entry and provider notification to ensure timely service within contract-mandated timeframes.

Essential Duties and Responsibilities

• Responsible for oversight of WC appointment types within providers schedules to ensure flow of patients is correct and matches the patients needs etc.
• Provides patients nurse case manager and adjusters with pre-registration instructions and directions to clinic locations.
• Efficiently and accurately gather and input patient demographic and payer and other necessary appointment information to ensure appointment is correct and can be billed correctly
• Obtains medical records and documents pertaining to the injury and treatment prior to appointments to ensure continuity of care and support the clinic work-flow
• Obtain the prior authorizations for ancillary services ordered by the provider (MRI CT Physical Therapy Outside Referrals PRP injections Joint Medications etc.).
• Work with the nurse case manager and adjuster to obtain the prior authorization and schedule the procedure(s) in a timely manner.
• Schedules patient appointments in the clinic once injections tests and joint medication authorization is approved.
• Document all steps in the prior authorization process in the computer for all employees to have access to the information.
• Manage calendars/schedules to ensure tasks stay on track and all deadlines are met
• Handle confidential information and deal with professionals inside and outside the company with a high level of integrity and discretion
• Assist with communications administrative tasks and scheduling related to each patients case
• Act as a liaison with claims adjusters attorneys and patients to ensure all medical plans and obligations are met to their satisfaction
• Manage documentation and correspondence in strict confidence
• Responsible for oversight of case records requesting documentation and case workflow
• Accurately document all communication and patient accounts of all actions taken in the EHR
• Maintains quality service by following organization standards.
• Other duties as assigned.

Core Competencies

Action Orientation - Targets and achieves results overcomes obstacles accepts responsibility establishes standards and responsibilities creates a results-oriented environment and follows through on actions.

Communications - Communicates well both verbally and in writing. Effectively conveys and shares information and ideas with others. Listens carefully and understands various viewpoints. Presents ideas clearly and concisely and understands relevant detail in presented information.

Creativity/Innovation - Generates novel ideas and develops or improves existing and new systems that challenge the status quo takes risks and encourages innovation.

Critical Judgment - Possesses the ability to define issues and focus on achieving workable solutions. Consistently does the right thing by performing with reliability.

Customer Orientation - Listens to customers builds customer confidence increases customer satisfaction ensures commitments are met sets appropriate customer expectations and responds to customer needs.

Interpersonal Skills - Effectively and productively engages with others and establishes trust credibility and confidence with others.

Leadership - Motivates empowers inspires collaborates with and encourages others. Builds consensus when appropriate. Focuses team members on common goals.

Teamwork - Knows when and how to attract develop reward and utilize teams to optimize results. Acts to build trust inspire enthusiasm encourage others and help resolve conflicts and develop consensus in creating high-performance teams.

Professional Requirements

• Excellent organizational skills
• Strong communications skills
• Strong customer service experience
• Excellent time management skills and ability to multi-task and prioritize work
• Attention to detail and problem-solving skills

Regulatory Requirements

• High school diploma GED or equivalent
• Proven admin or assistant experience
• Previous medical software experience
• Workers comp experience required preferred
• Additional degrees business training experience and/or certifications may be combined to meet minimum qualifications
• Must have computer skills and dexterity required for data entry and retrieval of patient information.
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
• Must be proficient with Windows-style applications various software packages specific to role
• Educated on and compliant with HIPAA regulations; maintains strict confidentiality of client information

Skills

• Ability to communicate effectively in English both verbally and in writing
• Basic computer skills and knowledge
• Dependability
• Confidentiality
• Excellent writing and proofreading skills
• Solid calendaring organizational and multi-tasking skills
• Ability to work efficiently and meet deadlines
• Detail-oriented
• Ability to prepare responses to requests for information

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job the employee is regularly required to talk and hear. This position is very active and requires repetitive motions standing walking bending kneeling and stooping all day. The employee must frequently lift or move items weighing up to 50 pounds.