Claims Coordinator - Workers Compensation

Job Description

Job Description

Description :

Live your life in full motion!

Join our Team to put the FUN in functionality!!

We are the leaders in the orthopedic community of East Central Florida, The Orthopedic Clinic has served our community since 1961.

We get our patients back to the life they love with high quality, individualized orthopedic care. The Orthopedic Clinic is seeking an enthusiastic and driven candidate that has previous experience with worker comp claims to join our dedicated as a

Workers Compensation Coordinator.

The Workers Compensation Coordinator will provide concierge service for our private practice Workers Compensation line of business.

The responsibilities of this position include translating and maintaining working knowledge of work comp regulations and guidelines, coordinating appointments, processing claims, calculating the costs of service, and processing work comp A / R claims.

Our Workers Compensation Coordinator will be skilled in maintaining effective working relationships with co-workers, third party payors, and patients while maintaining exemplary customer service skills and a passion for quality healthcare.

We believe every patient should receive the best possible care, our practice offers an array of services specializing in general orthopedics, spine care, sports reconstruction, adult reconstruction and non-surgical treatments.

We currently have eleven Orthopedic Surgeons, one Interventional Pain Management Physician, Mid-Level Providers, and a Physical Therapy team who serve patients at four locations within Volusia and Flagler counties.

What the Workers Compensation Coordinator will be able to :

• Process Workers Compensation referrals, appointments and claims.
• Fill out and process authorization forms for the appropriate appointment type, i.e. special evaluation, IME’s.
• Prepare DWC-25 and transmit to appropriate parties.
• Prepare insurance claim forms or related documents and review them for completeness
• Skilled in exercising a high degree of initiative, judgement, discretion, and decision-making to achieve organizational objectives
• Answers inquiries and correspondence from carriers, referring physicians offices and insurance companies’
• Reading and comprehending explanation of benefits / HCFA forms
• Responsible for taking action on non-payment or zero pay claim, including contacting insurance companies as needed to diagnose, correct, and rebill claims
• Responsible for providing any information (medical records, itemized statements, etc.) required by insurance companies to overturn denied claims.
• Assist Patient Services staff with patient’s requesting advanced assistance with their account
• Reading and interpreting denials and filing appeals

Requirements :

Experience and Abilities :

• Minimum of High School Diploma
• Previous workers comp experience in private practice
• Previous customer service experience, preferably in medical / healthcare setting
• Proficiency in the use of Microsoft Office Products, EPM and EHR software applications, preferably Athena
• Valid Driver’s License / Clean driving record / Proof of auto insurance

The Orthopedic Clinic is an Equal Opportunity Employer and fully subscribe to the principles of Equal Employment Opportunity.

Applicants and / or employees are considered for hire, promotion and job status, without regard to race, color, citizenship, religion, national origin, age, sex (including sexual harassment, sexual orientation, and gender identity), disability or handicap, genetic information, citizenship status, veteran, or current or future military status or any other category protected by federal, state, or local law.

The Orthopedic Clinic is a drug free workplace all applicants under consideration for employment will be background checked as part of the hiring process.