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|Workers Compensation Specialist|
Company: University of Miami
Location: Miami, FL
Employment Type: Full Time
Date Posted: 05/11/2022
Expire Date: 07/11/2022
Job Categories: Healthcare, Other
Workers Compensation Specialist|
The Department of Workers’ Compensation CHDS has an exciting opportunity for a full time Workers’ Compensation Specialist position. The incumbent works in conjunction with Risk Management, adjusters, case managers and TPAs (Third Party Administrator) to coordinate appointments for work related injuries across service lines system wide. Workers’ compensation services include but not limited to registration, scheduling, obtaining authorization, analysis, making referrals, and forwarding medical documentation to appropriate parties.
Core Job Functions
Acquire pertinent information to do a complete patient registration in UChart – including demographics, workers’ compensation insurance information, authorization, etc.
Obtain single case agreements when needed; inform non contracted carriers of acceptable fees In a timely manner.
Assign/schedule cases to specific subspecialties based on diagnosis; scan medical documents into UChart (if any)
Coordinate/schedule ancillary services (MRI, X-rays, etc.) when necessary
Coordinate plan of care and provide ongoing communication with patients, Adjusters, Case Managers, employers, insurers and other regulatory agencies.
Financially clear all workers’ comp cases at least 72 hours prior to visit (financial clearance preferred within 48 hours after a visit)
Send out email remainders alerting core managers (in patient access, the clinic, department) of upcoming WC visits at least 24 hours before the visit
Work with Patient Access managers to ensure that f/u visits are scheduled appropriately using the correct WC guarantor (to facilitate accurate billing)
Retrieve DWC-25 forms from specialists within 24 hours; review for compliance and accuracy; scan into UChart; forward forms along with medical notes to Adjusters, Case Managers, etc.
After exhausting all efforts, escalate outstanding DWC-25 forms to management after 72 hours Maintain an open line of communication with specialty departments, providers, Adjusters, Case Managers, TPAs, etc. to answer questions and address concerns relating to WC issues.
Attend staff meetings and do site visits as necessary to in-service staff and outline expectations regarding workers’ comp WC Clinic.
Obtain all signatures necessary for consents for treatment, releases of medical information and obtain copies of necessary identification.
Check-in / Check-out patients; escort patients when necessary to ancillary department; validate parking; assist Medical Director and ARNPs when necessary.
Answer phone calls and route appropriately Assist patients, TPAs, Adjusters, etc. with any bills or billing concerns as necessary
Other duties as assigned
Provides excellent customer service as per Diamond Standards Create and provide statistical reports as requested.
Two to Four Year College Degree preferred but can be substituted for 4 – 6 years’ experience in a healthcare setting dealing with workers’ compensation, patient accounts and/or managed care contracting.
Familiarity with automated patient accounting systems, electronic billing systems.
Computer literate; Proficient in Microsoft (Excel, Word & Power point).
Public speaking, training and negotiation skills are essential.