Lead, Worker's Comp Specialist

ESSENTIAL FUNCTIONS

• Reviews workers compensation accounts and forms for accuracy and completeness.
• Takes inbound calls from patients and insurance to set up patient charts schedule appointments.
• Answers questions and provides information pertaining to well-defined areas which require interpretation of the policy.
• Responsible for sending documentation and orders for each patient visit to the correct carrier.
• Interacts with claims adjustors to verify patients work status and scheduled appointments.
• Communicates verbally and in writing regarding the interpretation of local and out-of-state guidelines and policies.
• Maintains all records and reports.
• Responds to telephone calls from internal staff patients adjusters and case managers.
• Obtains authorizations for initial visits surgeries and physical therapy.
• Trains all new hires and re-trains current employees as necessary.
• Assists the manager in creating implementing and monitoring new and existing processes and protocols.
• Other duties as assigned.
• The job holder must demonstrate current competencies for this position.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• Two years medical billing or medical business office experience in a physician office or hospital environment;
• Workers Compensation experience is preferred.

REQUIREMENTS

• Excellent verbal and written communication skills.
• Experience working with Microsoft applications including Word. Excel and Outlook.
• Ability to work productively in a fast-paced environment.
• Ability to learn and retain company policies state and federal policies and workflow processes.

KNOWLEDGE

• Knowledge of workers compensation and/or healthcare insurance
• Knowledge of billing and related functions and tasks.
• Knowledge of workers compensation processes and requirements.
• Knowledge of payer-specific requirements state and federal regulations.
• Knowledge of physician group operation and clinic policies.
• Knowledge of authorization and verification processes.

SKILLS

• Skill in the billing authorization and collection process for workers compensation claims.
• Skill in obtaining necessary approvals for workers compensation to reduce denials.
• Skill in Microsoft applications specifically Excel and Access.

ABILITIES

• Ability to proficiently use arithmetic calculations in data collection and interpretation.
• Ability to use interpersonal skills to establish/maintain cooperative relationships with patients families physicians management and other staff.
• Ability to communicate openly and honestly with management and staff.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment

PHYSICAL/MENTAL DEMANDS

• This can occasionally be a high-stress work area requiring the ability to make quick decisions while being organized and prioritizing appropriately.
• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching are required.
• Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission Vision and Values must be acknowledged and adhered to

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities knowledge skills abilities and working conditions may change as needs evolve.

Required Experience:

IC