Professional Diversity Network

Collects all medical documentation needed to obtain pre-authorization/certification from payers in a timely manner.. Provides problem resolution in a professional and timely manner, researching inaccuracies and initiating corrections or clarifications of workers' compensation information and/or billing.. Preferred certification in Breath Alcohol Technicians (BAT) and urine drug screens.. Microsoft Word or Word Perfect, MS Excel, Power Point, Electronic Mail required.. Knowledge of insurance filing and payment methods, to include Texas Workers' Compensation Rules and Regulations preferred.

case manager

Job Summary Coordinates and processes the daily flow of communication and documentation to obtain authorization for treatment or medical procedures for work-related injuries, illnesses or business-related health care. Essential Functions Of The Role <ul><li>OBTAINS AUTHORIZATION FOR TREATMENT AND MEDICAL PROCEDURES FROM INSURANCE AGENCIES, THE TEXAS WORKERS' COMPENSATION COMMISSION (TWCC), THE DEPARTMENT OF LABOR (DOL) AND OTHER AGENCIES TO FACILITATE TIMELY PATIENT CARE.</li><li>Accurately and promptly collects initial demographic patient data from patient and employer prior to scheduling non-emergency work related injury/illness appointments, maintains and updates OccMed database with required data.</li><li>Approves and coordinates all initial and follow up appointments in compliance with TWCC or DOL regulations.</li><li>Accurately and promptly prepares all required documentation to comply with TWCC regulations utilizing the OccMed database, prints and mails required forms to all interested parties.* Maintains an accurate working file on all patients with a work related injury/illness in compliance with departmental guidelines.</li><li>Reports work status of patient to appropriate parties in a timely manner.</li><li>VERIFIES INSURANCE COVERAGE FOR WORK RELATED INJURIES/ILLNESSES AND OBTAINS PRE-AUTHORIZATION TO ENSURE TIMELY PATIENT CARE AND PAYMENT FOR SERVICES RENDERED.</li><li>Promptly identifies whether patient's employer is a subscriber to the TWCC.</li><li>Collects all medical documentation needed to obtain pre-authorization/certification from payers in a timely manner.</li><li>Accurately enters all registration and billing information into computer system to direct billing to appropriate payer group prior to scheduling patient appointments.</li><li>Acts as liaison between patients, providers and payer groups to ensure relevant patient information is shared with the appropriate parties in a timely and professional manner.</li><li>Provides problem resolution in a professional and timely manner, researching inaccuracies and initiating corrections or clarifications of workers' compensation information and/or billing.</li><li>PROVIDES ADDITIONAL ADMINISTRATIVE SUPPORT TO ENSURE DEPARTMENT EFFICIENCY AND CONTINUITY OF SERVICE.</li><li>Collates data and accurately produces monthly WRID managerial reports.</li><li>Responds promptly and accurately to requests for patient information in accordance with established policies and procedures or, if unable or unqualified to assist, promptly routes calls to the appropriate party/department.</li><li>SERVES AS LEADER AND LIAISON TO REGIONAL CLINICS REGARDING ISSUES OF WORK RELATED INJURY/ILLNESS AND BUSINESS RELATED HEALTH CARE TO ENSURE CONTINUITY OF SERVICE.</li><li>Attends and participates in WRID quarterly staff meetings.</li><li>Effectively educates and supports regional clinics about TWCC/DOL rules and regulations, form preparation, referrals, pre-authorizations and use of SMS systems.</li><li>Assists patients and clients with difficult work related injury/illness management issues in a professional manner.</li><li>WRID Case Manager specific to Round Rock Region additional duties:</li><li>Preferred certification in Breath Alcohol Technicians (BAT) and urine drug screens.</li><li>Check patients in and out</li><li>Answers inbound calls</li><li>Conduct urine drug screens</li><li>Conduct breath alcohol tests</li><li>Manage referrals</li><li>Correct statement errors</li><li>Submit billing corrections </li></ul>KEY SUCCESS FACTORS <ul><li>Knowledge of medical terminology required.</li><li>Microsoft Word or Word Perfect, MS Excel, Power Point, Electronic Mail required.</li><li>Two years of college preferred.</li><li>Knowledge of insurance filing and payment methods, to include Texas Workers' Compensation Rules and Regulations preferred. </li></ul>Benefits Our competitive benefits package includes the following <ul><li>Immediate eligibility for health and welfare benefits</li><li>401(k) savings plan with dollar-for-dollar match up to 5%</li><li>Tuition Reimbursement</li><li>PTO accrual beginning Day 1 </li></ul>Note: Benefits may vary based upon position type and/or level Qualifications <ul><li>EDUCATION - H.S. Diploma/GED Equivalent</li><li>EXPERIENCE - Less than 1 Year of Experience </li></ul>PDN-9be99877-cb66-43f0-91bf-171def25942e

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