Responsible for developing, coordinating and communicating workers' compensation internal processes for the entire Medical Group. Ensures compliance with all workers' compensation guidelines and regulations throughout the Medical Group. Effective communication with workers' compensation carriers to obtain authorizations for services provided by CSVMG providers; with insurance representatives to understand data required to ensure timely claims filing and reimbursement. Liaison between the workers' compensation carrier and CSVMG clinics to gather and provide necessary patient information to ensure efficient processing of claims. Case coordination with the entire workers' compensation case including patient and insurance to ensure all services provided are authorized and collectible. Effective communication with designated billing agency to assist in denial management, appeals and resolution of any issues that may arise. Works with Medical Group providers and clinics to coordinate scheduling of workers' compensation cases timely as injuries require. Continuing education to ensuring knowledge of workers' compensation guidelines and regulations and adjust Medical Group policies and procedures as required.
EDUCATION: High School diploma or equivalent required. College education in business and/or accounting may substitute for experience on a year-for-year basis up to two years.
SKILLS: Ongoing familiarity in the abstraction and direction of required workers' compensation insurance data. Required to read and understand the diversity and complexity of injury compensation documents or workers' compensation insurance guidelines and regulations. Investigation skill in the industry to verify the patient's case has been accepted by the employer and insurance carrier. Establishes contacts and resources with workers' compensation insurance companies, in order to obtain prior authorizations, establish processes, and ensure payments for treatment. Assist in the coordination of ongoing patient treatment plan within the CSVMG clinics. Above average clear and comprehensive verbal and written communication skills to promote service excellence. Ability to work in stressful situations and perform multiple tasks simultaneously. Demonstrated computer proficiency within a Windows environment. Must be able to work independently. Must be able to read and decipher the state regulations regarding workers compensation documents. Demonstrated ability to professionally handle confidential information. Proven ability to maintain high standards of integrity. Strong organizational skills and attention to detail.
EXPERIENCE: Threeyears experience in billing and collections of workers' compensation claims in a clinic setting.
NATURE OF SUPERVISION:
-Responsible to: Director of Finance, Medical Group
- Bloodborne pathogen A
Works in clean, well-lighted, ventilated smoke-free environment.
Subject to stressful professional relationships. Working hours vary, with flexibility due to unexpected changes in schedule and emergencies.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.