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Impairment Rating Associate (IRA)

The Impairment Rating Associate (IRA) will be responsible for the scheduling, administrative preparation, billing and submission of internal Impairment Ratings (IR), and the preparation and submission of records to non-TMC physicians performing impairment ratings on TMC patients. Responsibilities also include checking bill status for employers and patients balances that are at least 30 – 61 days past DOS for Department of Labor (DOL).  The IRA will also provide administrative support to insurance carriers, employers, patients, clinics and administrative personnel. Based on business requirements, the IRA will be expected to perform other duties within the billing office as assigned by Supervisor.

Work Hours:

The normal work-week is 35-40 hours/week full-time, Monday through Friday as scheduled. Occasional overtime or variations (including evenings and Saturdays) may be required or authorized.

Education & Training:

  • Must have one of the following:
  • High School graduate or GED Certificate
  • Certification from accredited vocational medical training school
  • Associate’s Degree
  • 1 year work experience; or applicable business or medical training
  • Basic skills using routine office equipment: computer, copier, fax, and telephone

Essential Knowledge, Skills & Abilities:

  • Must possess good customer service skills
  • Must possess effective reasoning and deductive ability
  • Must be organized, detail oriented and able to adapt quickly to stressful work environment
  • Must be able to work in team environment, as well as independently
  • Must be able to communicate effectively in English (grammar, spelling, writing, and verbal skills)
  • Must be able to read, correctly interpret and follow written guidelines/protocols
  • Must be able to learn and apply new skills
  • Must be able to prioritize multiple tasks to work efficiently
  • Must be comfortable working with computers, numbers and organizing paperwork
  • Must have the ability to self-check to minimize errors
  • Must have the ability to use personal initiative for self-direction of work projects  
  • Must maintain confidentiality when dealing with medical information
  • Must consistently exhibit mature and tactful attitude
  • Accurate use of the 10-key adding machine by touch preferred
  • Medical software experience required, current TMC medical software experience preferred
  • Above average computer and keyboarding skills: Microsoft Word and Excel required, Outlook preferred
  • Basic knowledge of CPT and ICD-10 codes required
  • Knowledge of medical terminology, its spelling and abbreviations required
  • Basic knowledge of TWCC rules and impairment rating process
  • Ability to communicate in Spanish helpful
  • Medical transcription experience helpful

Essential Job Functions & Duties:

  1. Schedules Impairment Ratings (IR) to be performed by TMC Physicians
  2. Reviews external requests to determine appropriate action
  3. Sends patient a letter to contact AR/IRA (or C/IRA) to schedule appointment when records are received from external sources
  4. Schedules IR based on patient’s availability and physicians schedule provided by Professional Services Supervisor (PSS)
  5. Scans copies of medical records into Whiteboard and retains a copy for AR/IRA (or C/IRA) files
  6. Pulls all medical records relating to injury, makes copies and sends records to specified DDE within 3 days of receipt of request (If not mailed at least 3 days prior to appointment, records must be faxed or emailed); if TMC patient is being examined by DDE outside of TMC
  7. Maintains documentation of all notifications received and records sent including date (and time, if appropriate)
  8. Finalizes preparation of IR for submission to recipients by completing all the following within 7 days of IR appointment
  9. Gathers related HCFA’s, chart copies, Work Status Reports (TWCC-73) and match to narratives
  10. Mails, faxes or forwards to:
  11. Makes sure fax is sent to carrier – HCFA, narrative, TWCC-69, chart and TWCC-73
  12. Makes sure fax is sent to TWCC – narrative, TWCC-69, chart and TWCC-73
  13. Makes sure mail is sent to patient – copy of narrative, TWCC-69, chart and TWCC-73
  14. Makes sure billing includes – copy of narrative, TWCC-69, chart and TWCC-73
  15. Makes sure AR/IRA (or C/IRA) files are current– original HCFA, narrative, TWCC-69, successful fax reports of transmission, and copies of chart and TWCC-73
  16. Helps other areas if caught up in duties for IRA
  17. May help WRI and Occupational areas as needed
BILLING/COLLECTION DUTIES
  1. Customer Service
  2. Answers Collection phones
  3. Answers questions from internal and external customers in a professional manner
  4. Responds to requests from internal and external customers in a professional manner
  5. Reviews correspondence received for assigned accounts
  6. Reviews activity on account
  7. Contacts employer to request first report of injury (E-1) or to determine correct carrier
  8. Corrects case attached to patient
  9. Adds new information or corrects existing information on all Date of Service (DOS) relating to case  
  10. Prints HCFA(s)
  11. Requests copies of chart notes and TWCC-73
  12. Resubmits claim(s)
  13. Documents actions on account
  14. Reviews accounts balances that are at least 30 – 61 days past DOS based on established schedule
  15. Review weekly reports created by OBSS
  16. Reviews activity on account
  17. For accounts with no payment
  18. Contacts insurance carrier to determine claim status
  19. Contacts employer to request first report of injury (E-1) or to determine correct carrier
  20. Contacts patient to advise of claim status and request assistance in process
OTHER
    1. Interacts with staff members professionally
    2. Follows company policies and procedures (time and attendance, appropriate attire, etc)
    3. Correctly uses office equipment
    4. Works safely
    5. Other duties as assigned
    6. Must be punctual and reliable in attendance
CUSTOMER SERVICE SKILLS:
  1. Meets the service expectations of patients
  2. Resolves problems identified by patients
  3. Meets the service expectations of internal customers
  4. Resolves problems identified by internal customers
  5. Meets the service expectations by external customers
  6. Resolves problems identified by external customers
  7. Follows through on commitments
  8. Interacts with co-workers in other departments in a manner that promotes teamwork and facilitates company goals

Working Conditions & Risks:

Work is indoors in a well lighted, and seasonally heated and cooled business office.  Job hazards are estimated to be minimal (low risk). Potential risk exists from accidents while using routine office equipment.

Physical Requirements:

Position requires occasional need to lift heavy (30-50 lbs) boxes from chest height to floor to chest height. Prolonged sitting, sorting, moving about, and intermittent typing approximately 4-6 hours per day routinely. Good vision, good hearing, and clear speech required (correctable). Repetitive motions consist of extended periods of upper body and upper limb movements (arms, hands, and wrists). Prolonged use of phone and computer.


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