Work Comp Specialist

Glenwood Medical Associates, PC•Glenwood Springs, CO

3d•Hybrid

About The Position

The Workers’ Compensation Specialist is responsible for managing all aspects of workers’ compensation claims within the medical practice. This position serves as the liaison between injured workers, employers, insurance carriers, adjusters, case managers, and healthcare providers to ensure timely authorization, accurate billing, compliance with state regulations, and efficient claim resolution.

Requirements

Basic computer skills
Some collection experience
Must be able to establish priorities, meet deadlines, work well under pressure
Must be a team player

Nice To Haves

Previous medical office experience
Knowledge of debits and credits
Knowledge of CPT and ICD-10 coding

Responsibilities

Verify workers’ compensation insurance coverage and claim information.
Obtain and document employer, insurance carrier, and adjuster information.
Secure treatment authorizations and referrals as required.
Schedule and coordinate appointments for injured workers.
Maintain accurate workers’ compensation records within the electronic medical record (EMR) system.
Communicate with employers, adjusters, nurse case managers, attorneys, and patients regarding claim status and treatment plans.
Review medical documentation for completeness and compliance with workers’ compensation requirements.
Process and submit workers’ compensation billing and supporting documentation.
Monitor accounts receivable and follow up on unpaid or denied claims.
Research and resolve billing discrepancies, denials, and reimbursement issues.
Ensure compliance with state workers’ compensation regulations and payer guidelines.
Track physician reports, work status forms, and return-to-work documentation.
Prepare reports and provide updates to management regarding claim activity and reimbursement trends.
Assist providers and clinical staff with workers’ compensation procedures and documentation requirements.
Maintain confidentiality of patient and claim information in accordance with HIPAA regulations.
Assists with the training of other PFS staff
Attends educational classes when necessary to enhance knowledge base
Other duties as assigned by PFS Supervisor or Manager
Must be able to travel between offices as requested.