Workers Compensation Integrated Specialist

Position Summary: The Worker’s Compensation 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.  

Qualifications:

• High School Diploma or General Education Degree (GED)
• Required 2+ years Florida and Federal Worker’s 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

Key Responsibilities:

• Follow the Florida state and federal Worker’s 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
• Ensure compliance with all company policies and procedures
• All other duties as assigned

At FOI our goal is to provide our patients with world-class orthopedic care. 

Our mission of providing the best care encompasses not only the care the physician provides, but all medical and administrative aspects of the patients encounter with Florida Orthopaedic Institute (FOI) as well. Every staff member plays a vital role in this mission. We take pride in receiving the Patriot Award from the Department of Defense for the support that we give to National Guard and Reserve members who are employed by FOI. We are committed to encouraging a culture of inclusion reflective of the communities we serve, and we provide equal opportunity to all. Florida Orthopaedic Institute conforms to the spirit as well as to the letter of all applicable laws and regulations. 

What We Offer:

• Full time opportunities available, with room for career growth and advancement. 
• Excellent job security and stability, to promote an optimal work life balance. 
• Be part of this dynamic and growing high level Work Comp team!