Job Details

Worker's Compensation Representative

Position Summary

Responsible for facilitation of medical authorizations by workers' compensation carriers for services rendered to patients covered under workers' compensation claims.

Qualifications

• Experience managing workers' compensation processes in accordance with carrier authorizations and guidelines
• Proven ability to ensure accurate, compliant, and timely submission of workers' compensation authorization requests
• Strong knowledge of workers' compensation regulations, payer requirements, and authorization protocols
• Skilled in coordinating with workers' compensation carriers, providers, and patients to resolve workers compensation authorization issues
• Effective communicator with the ability to serve as a liaison between clinical teams and insurance carriers

Duties and Responsibilities

• Prepare requests for treatment to be authorized by workers' compensation carriers, both state and federal claims, via fax, email, and online.
• Correspond with all workers' compensation adjusters, nurse case managers and attorneys to ensure we get a response and that it's in accordance with guidelines.
• Prepare 1010A's and 1009's when necessary and justified.
• Keep record of all new patient referrals, patients that do not show up for or cancel their appointments, all requested treatment sent out for approval, and all requested treatment that is denied.
• Operate office equipment, such as voice mail messaging systems, facsimile, scanner, and use work processing, spreadsheet, or other applications to prepare reports, invoices, financial statements, letters, case histories, or medical records.

Requirements

Education:

High school diploma or GED

Experience:

• Minimum two to three years of experience in medical billing. Must be able to communicate effectively with physicians, patients and the public and capable of establishing good working relationships with both internal and external customers.

Requirements:

• Medical office experience. Knowledge of workers compensation processes and guidelines.

Knowledge:

1. Knowledge of the physician billing processes, 1010A's and 1009's.
2. Knowledge of computer systems.
3. Advanced computer knowledge, including Window based programs.

Skills:

1. Skill in customer service and an understanding of LOS' code of conduct.
2. Skill in using computer programs and applications including Microsoft Excel, Microsoft Word and Outlook.
3. Skill in establishing good working relationships with both internal and external customers.

Abilities:

1. Ability to multi task in a fast- paced environment. Must be detailed oriented with strong organizational skills.
2. Ability to understand patient demographic information and determine insurance eligibility.
3. Ability to work independently and demonstrate the ability to analyze data.

Environmental/Working Conditions:

• Normal office environment.

Physical/Mental Demands:

• Requires sitting and standing associated with a normal office environment. Some bending and stretching required. Manual dexterity using a calculator and computer keyboard.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.