Onsite Workers’ Comp Specialist — Preauth & Liaison

Semmes Murphey; Memphis (TN); Hybride; USD 42 000 - 54 000; Plein temps

Résumé du poste

Semmes Murphey Clinic is seeking a Workers’ Compensation Specialist to join our team onsite from 8:00 am to 4:30 pm, Monday through Friday. The role focuses on obtaining financial medical clearance for patient treatment from various workers’ compensation companies, supporting patient services and coordinating with clinical staff.

You will precertify diagnostic tests and procedures, communicate with insurance adjusters and nurse case managers, and maintain confidential patient information in EMR

Qualifications

• High school diploma or equivalent.
• 1 year relevant work experience including precertification in workers’ compensation.
• General knowledge of Workers’ Compensation and HIPAA regulations.
• Proficient knowledge of insurance requirements and medical terminology.
• Proficient in Microsoft Office (Excel, Outlook, Word).
• Effective communication, both oral and written.
• Excellent organizational skills with attention to detail.
• Knowledge of EMR systems.

Responsabilités

• Obtain intake information and precertification for initial evaluations and follow-up visits; precertification of diagnostic and radiographic tests, surgeries and other procedures.
• Communicate with insurance claim adjusters and nurse case managers via telephone, email and fax.
• Act as a liaison between the clinical staff and the work comp claims adjustor/nurse case manager.
• Communicate and work closely with insurance and billing, nursing and physician staff.
• Maintain patient account information by obtaining, recording and updating medical treatment clearance.
• Maintain confidentiality; adhere to all HIPAA guidelines/regulations.

Connaissances

Effective communication

Organizational skills

Customer service

Attention to detail

EMR knowledge

HIPAA regulations knowledge

Formation

High school diploma or equivalent

Outils

Microsoft Office

Description du poste

Description

Semmes Murphey Clinic's mission is to deliver the best care for people suffering from neurological illness while advancing the field of neuroscience.

The Workers’ Compensation Specialist will work with other members of Semmes Murphey Clinic to provide patient services and is expected to participate in the appropriate team activities with the objective of providing a high standard of patient and clinical service. This position is responsible for obtaining financial medical clearance for patient treatment from various workers’ compensation companies.

This role is an onsite position with hours of 8:00 am to 4:30 pm, Monday to Friday.

Key Responsibilities

• Obtain necessary intake information, authorization for initial evaluations and follow-up visits; precertification of diagnostic and radiographic tests, surgeries and other procedures
• Communicate with insurance carrier claim adjusters and nurse case managers via telephone, email and fax
• Act as a liaison between the clinical staff and the work comp claims adjustor/nurse case manager
• Communicate and work closely with insurance and billing, nursing and physician staff
• Maintain patient account information by obtaining, recording and updating medical treatment clearance
• Maintain confidentiality; adhere to all HIPAA guidelines/regulations

Requirements

Minimum Requirements

• High school diploma or equivalent
• One (1) year relevant work experience that includes precertification in workers’ compensation

We are looking for someone who is/has:

• General knowledge of Workers’ Compensation and HIPAA regulations
• Proficient in Microsoft Office (Excel, Outlook, Word)
• Effective communication, both oral and written
• Excellent organizational skills with attention to detail
• Proficient knowledge of insurance requirements and medical/clinical terminology
• Knowledge of internet software and electronic medical records (EMR)
• Ability to provide excellent customer service during difficult or emotional situations
• Ability to manage workflow and prioritize demands

Equal Opportunity Employer/Veterans/Disabled

#SMC