Workers Compensation Specialist

Resurgens Orthopaedics; Fort Worth (TX); On-site; USD 42,000 - 60,000; Full time

Job summary

Resurgens Orthopaedics in Alliance is seeking a Workers' Compensation Specialist for an onsite role. The specialist acts as the liaison among patients, insurance carriers, and physicians in a fast-paced clinic environment.

Responsibilities include obtaining complete injury information, maintaining medical charts, verifying eligibility, and handling pre-certifications and authorizations. Strong communication and confidentiality are essential.

Qualifications

• High School Diploma or GED required.
• Worker's Comp experience in a clinical setting preferred.
• Referral intake experience in an ortho setting is a plus.
• Knowledge of TWCC rulings and forms preferred.
• Ability to use patient management systems and billing software.

Responsibilities

• Obtain complete patient and injury information before scheduling.
• Create and maintain a medical chart for workers' comp patients.
• Verify injury details with employer personnel and insurance.
• Translate between provider and patient as needed.
• Ensure accurate insurance billing information and authorization needs.
• Enter demographics accurately into the billing system for first visits.
• Obtain pre-certifications and authorizations daily.
• Maintain confidentiality of patient information and records.
• Answer calls, schedule appointments, and inform staff of changes.

Skills

Workers' Comp

Medical admin

Patient communication

Education

High School Diploma or GED

Tools

EPIC

Job description

Job Type

Full-time

Job Summary:

We are seeking an experienced Workers' Compensation Specialist to work in our Alliance location. The Workers' Compensation Specialist is the liaison between the patient, insurance carrier, and physician and works in a fast-paced position.

Onsite role

Key Functions:

• Obtains complete and accurate patient and injury information before scheduling appointments. Creates and maintains a Medical Chart on all workers comp patients.
• Verifies work related injury information with proper employer personnel.
• Verifies eligibility of injury and insurance benefits with insurance carrier representative.
• Translates between provider and patient as needed.
• Obtains correct insurance carrier billing address and claim number if assigned.
• Ensures proper documentation is attached to billing claims before submission or re- submission of the claims.
• Enters complete and accurate demographics into the billing system to ensure proper billing before the patient's first visit.
• Obtains pre-certifications and authorizations for treatment on a daily basis.
• Ensures completion of all TWCC required forms.
• Performs various collection activities to ensure payment is received and posted for each account. Contacts carriers, patients, or employers as needed to obtain/provide account information.
• Interprets appointment request and schedules patient appointment based on clinic policies. Identifies any problems with making the appointment and advises Physician and/or Manager.
• Checks answering service & reminder call email each morning for patient messages.
• Obtains patient's demographic information, insurance policy and medical issue.
• Informs patient about new patient and payment policies & referrals.
• Verifies insurance for same day add-on appointments.
• Relays relevant information to the Clinic Front Desk, Medical Records and appropriate internal staff when adding or changing an appointment.
• Provides any special needs of the patient to the Physician.
• Answers telephone, screens calls, takes messages, transfers calls to the appropriate area and provides information to keep the patient and clinic staff fully advised regarding appointments scheduled.
• Answers questions regarding patient appointments as requested.
• Makes necessary patient and/or policyholder information corrections in the Appointment System as necessary and advises the Patient and Billing.
• Safeguards patient information and ensures all information remains confidential.
• Request assistance from the Biller or Collectors for difficult account billing questions.
• Participates in office meetings and educational activities.
• Maintains work area in neat and orderly manner.

Requirements

• High School Diploma or GED, required.
• Must have Worker's Comp experience in a clinical setting-Strongly Preferred
• Referral Intake experience in an ortho setting preferred.
• Graduate of accredited program in Medical Administration, preferred.
• Knowledge of TWCC rulings and forms strongly preferred.
• Ability to read, understand and master policies and regulations.
• Ability to use patient management systems and computer software (e.g., patient billing & collecting system, electronic medical record system, word processing).
• Ability to interact and communicate well with patients, staff, and vendors.

Requirements

Worker's Comp experience and EPIC experience is a PLUS!!!