Workers Comp Patient Care Coordinator - Dr. Hrubes

Hospital for Special Surgery•New York, NY

2d•Onsite

About The Position

This role provides comprehensive administrative and operational support to Dr. Melody Hrubes’ practice. The primary responsibilities include serving as a liaison between Workers' Compensation claimants and HSS services, as well as with Workers' Compensation Insurance Companies and specialty providers to ensure a seamless transition of information, authorizations, and other necessary documents. The position involves gathering documentation, investigating and processing workers' compensation claims, and managing the full cycle of claims from intake to resolution. The coordinator must stay updated on federal and state workers' compensation regulations, obtain authorizations for services, and coordinate approved medical services. This role also focuses on ensuring patient needs are met, delivering quality customer experiences, and providing education to providers and their staff on proper procedures. The coordinator will compile reports, maintain case files, and monitor claimant case histories. The position requires strong organizational, communication, and customer service skills, with the ability to multitask in a fast-paced environment and work collaboratively.

Requirements

Experience with Epic Medical Records System required
Strong computer skills required
Excellent interpersonal communication to maintain positive and productive working relationships
Experience working with insurance carriers, claims adjusters, and legal professionals
Experience dealing with claim investigations, settlements, litigation, and denials
Demonstrated knowledge of NYS Worker’s Compensation Law
Demonstrated ability to successfully manage multiple tasks simultaneously demonstrating flexibility and creativity.
Superior written and oral communication skills
Exceptional customer service skills
Ability to follow through with tasks to completion
Strong organizational and problem-solving skills
Ability to multitask in a fast-paced environment
Ability to effectively and accurately follow directions or instructions
Ability to work collaboratively as part of a team; offers to help coworkers when needed
Detail-oriented
Ability to escalate issues appropriately
Consistently displays a positive attitude towards one’s work and work environment
Knowledge of healthcare and health insurance, required
Familiarity with medical terminology and general office protocol required.
Ability to type 45-60 words per minute and exceptional organizational strengths is required.
Must be proficient in Microsoft Word, Excel, and PowerPoint.
High School Diploma or equivalent
At least two years of related MD office/healthcare experience
At least two (2) Worker's Compensation experience (State workers compensation experience required; State and Federal preferred)

Nice To Haves

Associates Degree preferred
Relevant certifications (e.g., Certified Workers' Compensation Professional - CWCP) are preferred

Responsibilities

Serve as liaison between the entry point of a Workers' Compensation claimant and all pertinent HSS services involved.
Serve as liaison with Workers' Compensation Insurance Companies and specialty providers to ensure a seamless transition of information, authorizations, and any other identified documents.
Gather all documentation from visits and submit to claims' adjusters and nurse case managers as required.
Verify accidents with claimants.
Investigate and process workers' compensation claims.
Create and manage the full cycle of workers' compensation claims, including intake, investigation, documentation, and resolution.
Stay up to date on federal and state workers' compensation regulations to ensure compliance in all aspects of claims management and reporting.
Obtain authorizations for services, document approvals within the Electronic Medical Record, and coordinate and schedule approved services.
Provide case coordination and oversight to streamline and expedite the provision of medical services to maintain good relationships with insurance carriers and HSS.
Facilitate all adjuster and nurse case management needs to ensure recurrent referrals.
Ensure needs of patients are being met and that quality customer experiences and outcomes are being delivered.
Provide education and support to providers and providers' staff to ensure proper pre-service, documentation, and authorizations processes are followed.
Compile and distribute reports as requested.
Establish and maintain case files, logs and indexes.
Monitor claimants’ case histories, including any previous claims.