Workers Comp Rep - South Bend

South Bend Orthopaedics (SBO) provides specialized care for all musculoskeletal surgery and orthopedic rehabilitation patients, as well as those suffering from work-related and sports injuries. Founded on the principle of providing excellence in orthopedics, SBO has been serving the needs of the northern half of Indiana and southern Michigan since 1947 and functions as the Orthopaedic Surgeons for The University of Notre Dame Athletics Department since 1949. Services include joint replacement, sports medicine, upper and lower extremity surgery, pain management, diagnostic imaging, physical and occupational therapy. With 20 physicians and surgeons, plus multiple advanced practitioners across several locations, SBO is proud to be the trusted orthopedic expert for South Bend and the surrounding region – and a proud partner practice of OrthoAlliance.

At SCA Health, we believe health care is about people – the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the mission, vision and values that define our organization. 

As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.  

What sets SCA Health apart isn’t just what we do, it’s how we do it. Each decision we make is rooted in seven core values: 

• Clinical quality 
• Integrity 
• Service excellence 
• Teamwork 
• Accountability 
• Continuous improvement 
• Inclusion 

Our values aren’t empty words – they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.    

At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Please visit, https://careers.sca.health/why-sca, to learn more about our benefits.

Your ideas should inspire change. If you join our team, they will. 

Position Summary:

          Serves as external and internal relations for injured worker and group practice. Facilitates access to treatment of a compensable injury or condition. Processing of all work comp claims, including pre-certification.

Position Responsibilities/Standards:

Specific Duties

• Screen all WC claims to ascertain status of claim.
• Assist physician/staff regarding injured worker as needed.
• Schedule all new work comp appointments and rechecks.
• Update all WC charts, allowed condition(s), DOI, Case Manager, etc.
• Review and complete forms necessary for support of claim
• Obtain required prior authorization for services as needed.
• Follow up on approvals/disapprovals
• Communicate with physicians, Case Managers, Employers, Injured workers, Claims Adjusters.
• Review physician appointment schedules for WC patients to determine if there are any outstanding issues.
• Answer phones/call appropriate parties as needed. 

Additional SBO WC duties

• Complete all new incoming WC referrals, obtain all needed information for claim.
• Obtain medical records, and scan into chart
• Organize and sort all documents to scan into charts
• Gather & send required documents/dictations to insurance adjuster/Case Manager/Employer after every appointment.
• Maintain working relationships with local employers and Case Managers.

• Must be high school graduate or equivalent.