Workers' Compensation Coordinator

shm; United States; On-site; USD 42,000 - 60,000; Full time

Job summary

shm is seeking a Workers' Compensation Coordinator to schedule and coordinate Workers' Compensation appointments, referrals, and authorizations. The role involves collaborating with payers, employers, and patients to secure pre-authorizations and maintain accurate patient records.

The position requires experience in scheduling, customer service, and call-center environments, with focus on HIPAA compliance and cross-department collaboration to ensure timely care for workers' compensation cases.

Qualifications

• Bachelor's Degree in Public Health, Business, Hospitality Management or other applicable degree preferred.
• Experience with Patient Scheduling preferred.
• Experience working in a Call Center preferred.
• Experience (incomplete text)

Responsibilities

• Schedule Workers' Compensation appointments in a timely manner.
• Obtain initial authorizations to treat and pre-authorizations for orders from payer contacts.
• Build patient Athena chart and register accordingly with policy and authorization details.
• Verify required Workers' Compensation intake forms are completed by the patient pre-visit.

Skills

Customer service

Call center

Scheduling

Education

Bachelor's degree in Public Health/Business/ Hospitality management

Tools

Salesforce

Referwell

Job description

About Our Company

We're a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical , Village Medical at Home , Summit Health , CityMD , and Starling Physicians .

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com.

Job Description

The Workers' Compensation Coordinator is responsible for the scheduling of all Summit Health Workers' Compensation appointments, in addition to the coordination of referrals, whether from CityMD to Summit Health or Summit Health to Summit Health. The individual will be expected to collaborate with payers (adjusters, nurse case managers, claims examiners), employers and patients to obtain initial authorizations to treat, verify pre-visit intake information, and obtain pre-authorizations.

Duties and Responsibilities

• Schedule Workers' Compensation appointments in a timely manner, whether from CityMD referral or external payers/patients.
• Obtain initial authorizations to treat and pre-authorizations for advanced treatment orders from payer contacts (nurse case managers, adjusters, etc.) before scheduling.
• Build patient Athena chart and register accordingly by ensuring Workers' Comp Case Policy is up-to-date with claim information and authorization details, and linked to the appointment
• Verify required Workers' Compensation intake forms are completed by the patient pre-visit; engage with patient if forms are not completed; make updates in Athena where necessary.
• Communicate with patients and payer contacts, via phone and email, in a professional and courteous fashion when needed to discuss Workers' Compensation information, patient preferences, appointment coordination, etc.
• Conduct outbound calls to employers, adjusters and nurse case managers regarding CityMD referrals ordered, Workers' Compensation information needed, appointment scheduling, etc.
• Assist and manage inbound calls and emails from employers, adjusters, nurse case managers and patients regarding Workers' Compensation referrals and appointments.
• Review cancelled Workers' Compensation appointments, communicating any appointment changes to the adjuster/nurse case manager, and facilitate rescheduling the patient.
• Engage with Summit Health offices directly who have scheduled appointments on their own and do not comply with centralized Workers' Compensation workflows/resources.
• Leverage CRM Salesforce to reference client (employer and payer) referral coordination needs and special instructions.
• Utilize Referwell referral management technology to determine the most appropriate provider for scheduling a referral.
• Track all activities and progress of referral cases and appointments scheduled (outreaches, referral status, appointment scheduling progress, etc.)
• Daily extensive computer use navigating multiple applications while engaging in conversations with payer contacts, employers, patients or clinical office staff.
• Follow all HIPAA and any other governmental or state agency requirements regarding the appropriate handling of PHI documents to patients, employers, payers and providers.
• Must adhere to the call center schedule while being accountable to follow specific call quality guidelines and measurements.
• Demonstrate exemplary customer service skills.
• Work closely with other departments including but not limited to Workers' Compensation Case Management, UC Referral Management, Aftercare, Medical Records, Compliance, and Revenue Cycle with the goal of ensuring that Summit Health-CityMD is providing high quality and appropriate care to all work-related injury patients and ensuring seamless operation processes for customer experience.
• Collaborate with Sales, Employer Concierge Services and Operations Teams to resolve issues and ensure the highest level of customer satisfaction.
• Other relevant duties as assigned.

Qualifications

• Bachelor's Degree in Public Health, Business, Hospitality Management or other applicable degree preferred
• Experience with Patient Scheduling preferred
• Experience working in a Call Center preferred
• Expe