Administrative Skills, Billing, Calendar Management, Centralized Operations/Management, Communication Skills, Community Health, Computer Skills, Contract Requirements, Detail Oriented, Diversity, Documentation, Electronic Medical Records, Establish Priorities, Fax Machines, Healthcare Providers, Interpersonal Skills, Liens, Lift/Move 25 Pounds, Mail Processing, Medical Office, Medical Records, Medicine, On Site Support, Patient Care, People Management, Physical Demands, Problem Solving Skills, Provider Contracting, Public/Media/Press/Analyst Relations, RFA, Requirements Management, Scholarship, Sports Management, Sports Medicine, Team Player, Telephone Skills, Time Management, Training/Teaching, Worker's Compensation
JOB TITLE: Workers’ Compensation Administrative Coordinator
DEPARTMENT: Tactical Sports Medicine / Central Billing Operations
LOCATION: On-Site
FSLA STATUS: Non-exempt
REPORTS TO: Tactical Sports Medicine Supervisor
COMPENSATION: $25.00 - $27.00 per hour
GENERAL PURPOSE OF THE JOB:
To provide administrative and clerical support for workers’ compensation processes, assist with front desk reception duties, and ensure timely patient care by proactively managing authorization requirements and documentation workflows.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Schedule appointments for WC patients via telephone, email or, in person
- Able to screen calls to determine appointment type, authorization requirements, contract requirements, provider availability
- Respond timely to all requests from providers or staff asking for patients to be scheduled, rescheduled, moved, etc.
- Review WC appointments scheduled by UHC front staff.
- Review cases referred directly from attorneys to ensure proper authorization is obtained, medical records are received, case is not in Denied status or delayed, not on a lien basis, etc.
- Calling patients who No Show for scheduled appointments or cancel without rescheduling to schedule next appointment.
- Ensuring patients, (where TSM is PTP), get scheduled for re-exams 6 weeks after exam at time of checkout.
- Monitor incoming faxes to the TSM and CBO inboxes to sort, enter in the EMR system, and scan all Work Comp related correspondence in chart.
- For all WC authorizations, enter Auth#, number of visits, body part approved in EMR to track for billing.
- Review UR requests with 24-hr deadline and forward ASAP to supervisor.
- Complete and return all MedRisk WC status requests received via fax.
- Review authorizations for new WC referrals, (Non-PTP), create account in EMR, and call patient to schedule appt based on authorized services, (i.e., Chiro, ACU, PT).
- Review all incoming authorizations for referrals to outside specialists and
- Save in chart
- Communicate authorization to specialist office, PTP provider, and send all relevant medical records.
- Track in Athena to add date patient is scheduled with the specialist, surgery done, etc.
- Confirm we receive a report of consultation or treatment rendered by the specialist and that it gets uploaded to Athena and PTP is notified.
- Keep track of new WC patients and call Sedgwick to obtain claim number once assigned and confirm accepted body parts and DOI. a.
- Assist in completing WC specific forms, (RFA, PR2, DFR), with patient and payer information.
- Save original form(s) in TSM specific folder to be accessed by all TSM staff.
- Forward copy of form(s) to provider when patient is scheduled for a reexamination. (Provider will complete clinical section).
- Collect payments for cash services as required.
- Create cash and student TSM and SM claims.
- Attach payment to cash claims and ensure account is balanced ii. Confirm student claim is created with correct fees, (most are $0).
- Review all incoming medical records requests, (i.e., subpoenas, payer requests, other medical providers, etc.).
- Prepare the invoice for medical records fee and secure payment prior to releasing records.
- Collect the medical records requested, (entire chart or selected date range), and send them to the requesting entity
- Able to communicate with various providers, when necessary, (i.e., remind them of missing information/paperwork, work-in patients, etc.).
- Work with the manager and supervisor to list missing or incorrect information.
- Answer calls from payers
- Able to provide work status to adjusters
- Answer calls regarding the next appointment scheduled, last appt, etc.
- Provide coverage when the supervisor is off.
- Review TSM schedules day before appointments
- Submit RFAs to payers on behalf of the providers
- Collecting all TSM or WC mail
- Sorting mail and forwarding urgent 24 visit cap letters to Valerie ASAP.
- Reviewing any paper authorizations received, (scanning in chart, entering in EMR, etc.)
ATTENDANCE
Reliable attendance is crucial. Must be punctual and timely in meeting all requirements of performance, including, but not limited to, attendance standards and work deadlines; beginning and ending assignments on time; and scheduled work breaks, where applicable.
WORK LOCATION
This position requires daily onsite support and/or attendance to meet the essential functions of the job.
INTELLECTUAL
Ability to pay close attention to details and ensure accuracy. Able to prioritize tasks, manage time effectively, and meet deadlines.
INTERPERSONAL
Ability to communicate and interact with patients, providers, and staff professionally and effectively. Ability to work as part of a team and collaborate with others toward the goal of supporting the TSM Department and its patients.
SUPERVISORY RESPONSIBILITIES:
This position has no supervisory responsibilities.
EDUCATION AND/OR EXPERIENCE:
3-5 years of office reception experience, primarily supporting workers’ compensation patients including processing authorization requests and managing all associated workers' compensation paperwork.
COMPUTER SKILLS:
Proficiency using EMR systems, Microsoft Teams, and Outlook.
PHYSICAL DEMANDS:
Typical physical demands of a standard medical office setting, including occasional lifting or moving of objects up to 25 pounds.
WORK ENVIRONMENT:
Capable of working in a dynamic indoor environment with frequent interactions involving multiple patients and providers. Demonstrates the ability to quickly shift focus and respond promptly to those requiring immediate attention throughout the day
SCU Core Values:
- Integrative Health: We teach, learn, collaborate, and lead by creating an open environment for multiple disciplines and professionals to bring their shared and unique skills together for the benefit of patients and students.
- Evidence-based Practice: We value a culture of inquiry, assessment, research, scholarship, and judicious use of current best evidence to inform our decisions and work.
- Health Equity: We value people equally. We strive to educate graduates that are prepared to improve individual and community health.
- Inclusivity: We welcome everyone regardless of age, race, ethnicity, class, religion, gender, gender expression, sexual orientation, disability, or any other similar or protected status. We believe inclusivity leads to more diversity in our reasoning, better representativeness in our conclusions, more ingenuity in our problem solving, and greater equity in our care