Workers' Comp Claims Specialist

Summit Spine and Joint Centers; Lawrenceville (GA); On-site; USD 45,000 - 60,000; Full time

Job summary

Summit Spine and Joint Centers in Lawrenceville, GA is seeking a WC Coordinator to manage patient coverage, status, and financial obligations. You will liaise with 3rd party attorneys and WC Insurance Adjusters to navigate the workers’ compensation process in a fast-paced practice.

The role requires strong communication, attention to detail, and the ability to document all interactions while coordinating with insurers, physicians, and legal professionals.

Qualifications

• Must be personable and detail oriented as a representative of the practice while callers rely on accurate information.
• Excellent verbal and written skills for proper documentation of encounters.
• Bilingual candidates are encouraged to support our diverse patient base.

Responsibilities

• Appropriately document all communications with patients, including regarding all actions, authorization details and modifications.
• Work accurately, work well independently and with others, and able to maintain focus under pressure.
• Liaison with insurance providers, legal professionals, and other healthcare providers to facilitate the timely processing of claims, continuity of care for patient treatment, and effective communication between all parties involved.
• Schedule Peer-to-Peer meetings between external insurance companies and in-house providers to resolve potential insurance coverage denials.
• Coordinate & schedule medical appointments, evaluations, and treatments for injured patients as necessary.
• Coordinate with physicians in completing monthly attending physician statements and worker’s compensation forms after each patient’s appointment.
• Providing any necessary medical notes, referrals, forms, and itemized statements to insurance providers, claims adjusters, nurse case managers, and legal professionals.
• Complete and submit WC205 forms and out of state request for authorization forms to adjusters and legal professionals to obtain approval for ambulatory surgical center appointments for patients.
• Obtain approvals for treatment from worker’s compensation adjusters and nurse case managers prior to initial treatment appointment.

Skills

Personable

Detail oriented

Verbal and written communication

Bilingual encouraged

Tools

EMR (EClinical Works)

Job description

Summit Spine and Joint Centers in Lawrenceville, GA is seeking a WC Coordinator to manage patient coverage, status, and financial obligations. You will liaise with 3rd party attorneys and WC Insurance Adjusters to navigate the workers’ compensation process in a fast-paced practice.

The role requires strong communication, attention to detail, and the ability to document all interactions while coordinating with insurers, physicians, and legal professionals.