Workers Compensation Specialist

TSAOG Orthopaedics & Spine; San Antonio (TX); On-site; USD 40,000 - 60,000; Full time

Job summary

TSAOG Orthopaedics & Spine is seeking a Professional Reimbursement Specialist for Workers' Compensation. The role focuses on managing incoming calls, referrals, and documentation to ensure proper processing and scheduling of patient cases.

The ideal candidate will have strong customer service, data entry accuracy, and proficiency with Microsoft Office. The position requires adherence to healthcare regulations and confidentiality, with opportunities to contribute to process improvements.

Qualifications

• Must have strong customer service skills and the ability to communicate effectively.
• Proficient data entry skills and accurate documentation are required.
• Prolonged sitting, repetitive motion, and phone handling are expected tasks.

Responsibilities

• Manage workers' compensation calls, faxes, emails and referrals.
• Communicate with adjusters, nurse case managers, referral sources, and physicians with required information.
• Assist other departments by providing or verifying workers' comp information as needed.
• Respond to and document patient cases to ensure proper processing and scheduling.
• Submit treatment orders to utilization review for approval and follow up to obtain authorization.
• Schedule patient appointments and workers' comp exams.
• Maintain knowledge of prior authorization requirements for efficiency.
• Collaborate with team on special projects as directed by supervisor.
• Follow directions from department lead, manager, and physicians.
• Support other areas in referrals/authorizations as staffing requires.
• Participate in monthly/quarterly department meetings to discuss policies and best practices.
• Adhere to healthcare laws and policies; protect patient confidentiality; complete compliance training.

Skills

Customer service

Data entry

Communication

Multitasking

Education

High School Diploma or equivalent

Tools

Microsoft Excel

Microsoft Word

Job description

Description

• Manage workers compensation incoming calls, faxes, emails and referrals
• Communicate effectively with adjusters, nurse case managers, referral sources, and physicians by obtaining or providing requested workers comp information on new or existing patients
• Assists other departments and physician teams by providing or verifying workers comp information when needed
• Responding to and documenting patient cases to ensure proper processing and scheduling
• Submit treatment orders to utilization review companies for approval and follow up to ensure complete authorization process
• Schedule patient appointments and workers comp appointed exams
• Maintain knowledge and education to be effective and productive on prior authorization requirements
• Work with individual department co-workers on special projects as requested by supervisor
• Follow the requests and directions of department Lead, Manager, Director, and physicians
• May be required to assist other areas in referrals/authorizations department when staffing is needed
• Participate in monthly and quarterly meetings within respective department and team to discuss policies, protocols, and best-practices
• Adhere to applicable healthcare laws, regulations, and orthopaedic practice policies and procedures, including requirements related to patient privacy, documentation, billing, and ethical conduct. Protects patient confidentiality, completes required compliance training, and promptly reports suspected compliance or ethical concerns.
• Comply with healthcare regulations and orthopaedic practice policies and procedures; ensures accurate documentation and ethical conduct; protects patient confidentiality; completes required compliance training; and reports compliance concerns in a timely manner.
• Comply with healthcare regulations and practice policies and procedures; protects patient confidentiality; and reports compliance or ethical concerns in a timely manner.

Job Title: Professional Reimbursement Specialist - Workers Compensation Key Responsibilities:

• Manage workers compensation incoming calls, faxes, emails and referrals
• Communicate effectively with adjusters, nurse case managers, referral sources, and physicians by obtaining or providing requested workers comp information on new or existing patients
• Assists other departments and physician teams by providing or verifying workers comp information when needed
• Responding to and documenting patient cases to ensure proper processing and scheduling
• Submit treatment orders to utilization review companies for approval and follow up to ensure complete authorization process
• Schedule patient appointments and workers comp appointed exams
• Maintain knowledge and education to be effective and productive on prior authorization requirements
• Work with individual department co-workers on special projects as requested by supervisor
• Follow the requests and directions of department Lead, Manager, Director, and physicians
• May be required to assist other areas in referrals/authorizations department when staffing is needed
• Participate in monthly and quarterly meetings within respective department and team to discuss policies, protocols, and best-practices
• Adhere to applicable healthcare laws, regulations, and orthopaedic practice policies and procedures, including requirements related to patient privacy, documentation, billing, and ethical conduct. Protects patient confidentiality, completes required compliance training, and promptly reports suspected compliance or ethical concerns.
• Comply with healthcare regulations and orthopaedic practice policies and procedures; ensures accurate documentation and ethical conduct; protects patient confidentiality; completes required compliance training; and reports compliance concerns in a timely manner.
• Comply with healthcare regulations and practice policies and procedures; protects patient confidentiality; and reports compliance or ethical concerns in a timely manner.

We offer a competitive salary and benefits package, along with opportunities for professional growth and development. If you are a motivated individual with a passion for reimbursement processes.

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Requirements

• Must have a High School Diploma or equivalent.
• Required knowledge of self-insured and network Workers Compensation programs, rules and regulations.
• Proficient computer skills. Exceptional customer service skills. Proficient and accurate data entry skills. Proficient with Microsoft programs (Excel, Word, etc.)
• Ability to communicate effectively. Excellent research, follow-through and documentation are required.
• Prolonged sitting. Repetitive motion (data entry), and phone contact.
• Ability to multi-task, prioritize work and make sound judgements.
• Other duties as assigned as necessary and may vary at times, as needed, by your immediate supervisor or as directed by the company.
• Requires predictable and consistent attendance