Lead, Worker's Comp Specialist

Healthcare Outcomes Performance Company•Phoenix, AZ

1d•Onsite

About The Position

ESSENTIAL FUNCTIONS Reviews worker’s 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 patient's 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; Worker’s 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 worker’s compensation and/or healthcare insurance Knowledge of billing and related functions and tasks. Knowledge of worker’s 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 worker’s compensation claims. Skill in obtaining necessary approvals for worker’s 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.

Requirements

High school diploma/GED or equivalent working knowledge preferred.
Two years medical billing or medical business office experience in a physician office or hospital environment; Worker’s Compensation experience is preferred.
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 of worker’s compensation and/or healthcare insurance
Knowledge of billing and related functions and tasks.
Knowledge of worker’s 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.
Skill in the billing authorization and collection process for worker’s compensation claims.
Skill in obtaining necessary approvals for worker’s compensation to reduce denials.
Skill in Microsoft applications, specifically Excel and Access.
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.
Normal office environment
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.
HOPCo Mission, Vision, and Values must be acknowledged and adhered to

Responsibilities

Reviews worker’s 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 patient's 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.