Specialist - medical

DUTIES AND RESPONSIBILITIES: 1) Verify workers' compensation insurance coverage and claim information.2) Obtain and document employer, insurance carrier, and adjuster information.3) Secure treatment authorizations and referrals as required.4) Schedule and coordinate appointments for injured workers.5) Maintain accurate workers' compensation records within the electronic medical record (EMR)system.6) Communicate with employers, adjusters, nurse case managers, attorneys, and patients regardingclaim status and treatment plans.7) Review medical documentation for completeness and compliance with workers' compensationrequirements.8) Process and submit workers' compensation billing and supporting documentation.9) Monitor accounts receivable and follow up on unpaid or denied claims.10) Research and resolve billing discrepancies, denials, and reimbursement issues.11) Ensure compliance with state workers' compensation regulations and payer guidelines.12) Track physician reports, work status forms, and return-to-work documentation.13) Prepare reports and provide updates to management regarding claim activity and reimbursementtrends.14) Assist providers and clinical staff with workers' compensation procedures and documentationrequirements.15) Maintain confidentiality of patient and claim information in accordance with HIPAA regulations.16) Assists with the training of other PFS staff 17) Attends educational classes when necessary to enhance knowledge base 18) Other duties as assigned by PFS Supervisor or Manager 19) Must be able to travel between offices as requested. CRITERIA FOR EVALUATION: Evaluated on thoroughness in the completion of duties, accuracy, pleasantattitude, dependability, initiative, professional appearance, and the use of tact and maturejudgment in relationships with co-workers and patients. Works as a team player with departmentstaff on end-of-month duties. REPORTING RELATIONSHIP: Reports directly to the PFS Manager.

SPECIAL QUALIFICATIONS: Previous medical office experience and knowledge of debits and creditspreferred. Knowledge of CPT and ICD-10 coding a plus. Must have basic computer skills and somecollection experience. Must be able to establish priorities, meet deadlines, work well underpressure. Must be a team player. PI6cbf 2f 6d 29ab-38271-41707935