Florida Orthopaedic Institute

The Work Comp Integrated Specialist is responsible for the coordination of referrals and authorizations from the insurance carrier, case management and/or employer in accordance to the company and state requirements while exhibiting excellent customer service.. Follow the Florida state and federal Workers Compensation fee schedule and guidelines. Send required documentation to the carrier and/or case management as instructed. Recommended knowledge of Six Sigma process improvement tools and methodologies. Must be detail oriented, handle multiple inquiries at a time, resourceful and a self-starter

integrated

The Work Comp Integrated Specialist is responsible for the coordination of referrals and authorizations from the insurance carrier, case management and/or employer in accordance to the company and state requirements while exhibiting excellent customer service.
Key Responsibilities:
Follow the Florida state and federal Workers Compensation fee schedule and guidelines
Register and update patient demographics and insurance information in the system
Schedule appointment(s) according to the patient need and physician protocol
Obtain written authorization and required documentation for service(s) from the insurance
carrier, case manager and/or employer
Ensure updated authorization is documented in the system
Communicate with the patient advising of the scheduled appointment(s)
Handle incoming calls and triage to the respective departments as needed
Send required documentation to the carrier and/or case management as instructed
Reschedule bumped appointment(s), and notify the patient and carrier of the schedule change
Conduct a quality check on the internal document(s) prior to sending to the carrier and/or case management
Reviews a portion of claims prior to the submission to the insurance carrier(s)
Works with the insurance carriers, third party and vendors to resolve payment and authorization issues
Serves as an internal escalation point of contact for other departments as needed
Identify improvement opportunities and provide solutions to management
Address internal and external email and fax correspondence as instructed
Ability to meet productivity and accuracy standards
Collaborate with the various departments to improve the customer experience
Assure compliance with all company plans, policies and procedures set forth by the Florida Orthopaedic Institute
All other duties as assigned.
Qualifications
High School Diploma or General Education Degree (GED)
Required 2+ years Florida and Federal Workers Compensation experience
Requires comprehensive knowledge of computer skills including Microsoft Office Suite
Excellent customer service and communication skills
Knowledge of ICD10, CPT HCPCS, bill types and the use of modifiers
Working Knowledge of medical terminology and human anatomy
Recommended knowledge of Six Sigma process improvement tools and methodologies
Must be detail oriented, handle multiple inquiries at a time, resourceful and a self-starter
Adapt in a fast-paced working and team environment

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