Workers' Compensation Specialist (2489)

• 30+ days ago

OrthoLoneStar

Role overview

Qualifications

Knowledge of WC injury/claim processes
Experience with medical record auditing
Ability to communicate effectively with adjustors and case managers
Understanding of DWC rules and regulations

Responsibilities

Verify all new and established WC injuries/claims
Audit WC appointments for comments/authorization/DWC
Prepare claims and documentation for filing
Facilitate physician’s use and understanding of ODG

Key facts

Remote from: Texas (USA), United States
Full time
Compensation Analyst
English

Hard skills

Other skills

Communication
Time Management

About the company

OrthoLoneStar

Medical Practices & Clinics
1,001–5,000

Quality focused, physician led healthcare. Proud to be the largest independent orthopedic practice serving Texas. Our divisions include Advanced Orthopaedics & Sports Medicine, Azalea Orthopedics, Fondren Orthopedic Group, Texas Orthopedics Sports & Rehabilitation Associates, Texas Orthopaedic Associates, and Carrell Clinic. We currently serve Dallas, Houston, Austin, Frisco, Fort Worth, Plano, Baytown, Clear Lake, Pearland, Athens, Jacksonville, Longview, Mount Pleasant, Nacogdoches, Palestine, Pittsburg, Tyler, Cypress, Houston, Spring, Tomball, Bastrop, Cedar Park, Kyle, Lakeway, Marble Falls and Round Rock.

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Job description

General Job Description

Handles verification of injury/claim of all WC patients including auditing medical record for billing accuracy. Responsible for marketing to employers/WC clinics and is the point of contact for adjustors and case managers.

ESSENTIAL FUNCTIONS

Call adjustors to verify all new and established WC injuries/claims per protocol
Audit WC appointments for comments/authorization/DWC
Prepare claims and documentation for filing
Point of contact for all adjustors and case managers
Facilitate physician’s use and understanding of ODG
Prepare DWC 73’s & 69’s
Authorization of all WC procedures
Timely Follow up on appeals for unpaid claims utilizing claims maintenance
Advise physicians on dispute cases including initiating Benefit Review Conferences
Remain up to date on DWC rules – including ODG treatment, RTW, Preauthorization and fee guidelines
AR Follow up to ensure claims are paid timely.
All other duties as assigned.

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