Workers Compensation Specialist

TSAOG Orthopedic & Spine•San Antonio, TX

2d•Onsite

About The Position

This is a full-time position for a Professional Reimbursement Specialist focusing on Workers Compensation. The role involves managing incoming communications, coordinating patient care authorizations, scheduling appointments, and ensuring compliance with healthcare regulations. The company offers a competitive salary and benefits package with opportunities for professional growth.

Requirements

High School Diploma or equivalent
Required knowledge of self-insured and network Workers Compensation programs, rules and regulations.
Proficient computer skills.
Exceptional customer service skills.
Proficient and accurate data entry skills.
Proficient with Microsoft programs (Excel, Word, etc.)
Ability to communicate effectively.
Excellent research, follow-through and documentation are required.
Ability to multi-task, prioritize work and make sound judgements.
Other duties as assigned as necessary and may vary at times, as needed, by your immediate supervisor or as directed by the company.
Requires predictable and consistent attendance

Responsibilities

Manage workers compensation incoming calls, faxes, emails and referrals
Communicate effectively with adjusters, nurse case managers, referral sources, and physicians by obtaining or providing requested workers comp information on new or existing patients
Assists other departments and physician teams by providing or verifying workers comp information when needed
Responding to and documenting patient cases to ensure proper processing and scheduling
Submit treatment orders to utilization review companies for approval and follow up to ensure complete authorization process
Schedule patient appointments and workers comp appointed exams
Maintain knowledge and education to be effective and productive on prior authorization requirements
Work with individual department co-workers on special projects as requested by supervisor
Follow the requests and directions of department Lead, Manager, Director, and physicians
May be required to assist other areas in referrals/authorizations department when staffing is needed
Participate in monthly and quarterly meetings within respective department and team to discuss policies, protocols, and best-practices
Adhere to applicable healthcare laws, regulations, and orthopaedic practice policies and procedures, including requirements related to patient privacy, documentation, billing, and ethical conduct.
Protects patient confidentiality, completes required compliance training, and promptly reports suspected compliance or ethical concerns.
Comply with healthcare regulations and orthopaedic practice policies and procedures; ensures accurate documentation and ethical conduct; protects patient confidentiality; completes required compliance training; and reports compliance concerns in a timely manner.
Comply with healthcare regulations and practice policies and procedures; protects patient confidentiality; and reports compliance or ethical concerns in a timely manner.