Orthopedic Surgery Workers Compensation Specialist

POSITION SUMMARY:

Under direct supervision of the Operations Supervisor the WCS provides clerical and administrative support to the orthopedic patients with musculoskeletal work-related injuries covered by workers compensation insurance. The WCS processes data generates routine reports and provides direct and timely support to claim representatives and patients. Additionally the WCS maintains office records appointments and calendars. Other duties include but are not limited to answering telephones facilitating communications between the WC stakeholders assisting with peer reviews filing mail processing document scanning preparing and handling letters and medicolegal document(s) and surgical pre-authorizations.

Position: Orthopedic Surgery Workers Compensation Specialist

Department: Orthopedic Clinic

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Developing maintaining and managing our internal workers comp program

• Investigating and processing workers compensation claims from the initial evaluation to surgical and discharge phases.

• Communicating with employees managers insurance carriers medical providers surgeons attorneys legal representatives and upper management regarding workers comp issues

• In collaboration with our Billing Director responding to claim investigations settlements and litigations.

• Keeping up-to-date with and closing the communication loop regarding claims processing status and denials

• Assisting our patients with reporting workplace injuries in a timely manner

• Scheduling and managing appointments (routine follow-ups IMEs etc.) and assisting the Medical Providers with scheduling depositions court appearances etc.

• Updating our internal workers compensation database (weekly) and producing monthly updated active case reports

• Dealing with claim investigations settlements and litigation issues.

• Handling communication of claims updates across all parties.

• Working within the various Workers Compensation laws rules and requirements for common requests such as accommodations restrictions and return-to-work.

• Obtain verification pre-certification pre-authorization and authorization for scheduled tests and procedures as needed

• Assist with scheduling: surgeries appointments imaging-diagnostics (MRI CT scan X-ray EMG/NCS Bone Density etc.) pre-Op clearance referrals etc.

• Contact the insurance or legal representative/attorney for case information to confirm client Information and appointments

• Act as the main point of contact for all injured patients with active WC cases

• Act as the liaison between the physician(s) the insurance carrier and the legal representatives.

• Communicate and inform patients regarding appointments and/or surgeries approval status

• Able to communicate promptly and clearly with attorneys adjusters physicians patients and involved staff.

• Must adhere to all of BMCs RESPECT behavioral standards.

JOB REQUIREMENTS

EDUCATION:

• Associates degree in a Business/Legal related field. Bachelors preferred.

EXPERIENCE:

• The job requires a minimum of three years of clerical and insurance management addition the ideal candidate will also possess at least one year work comp adjuster or case manager experience.

• Experience in the Orthopedic clinical setting a plus. Workers Compensation Analyst certification preferred but not required.

KNOWLEDGE AND SKILLS:

• Knowledge of administration of workers compensation program and applicable laws

• Ability to interpret explain and disseminate information to individuals and groups

• Effective communication and interpersonal skills

• Organizational and communication skills.

• Ability to develop spreadsheets databases PowerPoint and Word documents

• Knowledge of basic accounting principles.

• Ability to work well with external parties as well as co-workers.

• Strong critical thinking and analytical abilities.

• Ability to effectively present information in one-on-one and small group situations.

• Strong organizational analytical and problem solving skills.

• The ability to coordinate multiple projects with varying and changing priorities and to meet deadlines.

• Have the ability to work independently and collaboratively and possess strong customer-service

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However our approach to determining base pay is comprehensive and a broad range of factors is considered when making an offer. This includes education experience skills and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs internal equity and addition BMCHS offers generous total compensation that includes but is not limited to benefits (medical dental vision pharmacy) discretionary annual bonuses and merit increases Flexible Spending Accounts 403(b) savings matches paid time off career advancement opportunities and resources to support employee and family well-being.

NOTE: This range is based on Boston-area data and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

According to the FTC there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications or apps job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.