Work Comp Associate-A

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GENERAL JOB SUMMARY: The Work Comp Associate-A (WCA-A) is responsible for the following: 1) completes 30-day follow-up calls on outstanding bills for workers’ compensation claims for assigned Work Comp Collector (WCC) 2) processes Benefit Review Conferences (BRC) and Contested Case Hearings (CCH); 3) submits and follows up on Subscriber Private Pay letters; 4) sorts, distributes and processes correspondence and 5) provides clerical/filing support for the assigned Work Comp Account Representative (WCAR) or Work Comp Collector (WCC). Based on business requirements, the WCA-A will be expected to occasionally perform other duties within the billing office as assigned by Supervisor. This position prepares the employee for promotion to the WCAR position.

Work Hours:

WORK HOURS: The normal full-time workweek is 35-40 hours per week, Monday through Friday as scheduled (normally 8:00am-5:00pm with a one hour lunch). Occasional overtime (including evening and weekends) or variations may be required or authorized.

Education & Training:

EDUCATION AND TRAINING REQUIRED:

 

Must have High School diploma or GED

Must have one of the following:

 

o 1 Year related experience

o Certificate in related field plus 6 months work experience

 

 

Essential Knowledge, Skills & Abilities:

ESSENTIAL KNOWLEDGE, SKILLS, AND ABILITIES:

Must be organized, detail-oriented and able to adapt quickly to stressful work environment

 

• Must have effective reasoning and deductive ability

• Must be able to work in team environment, as well as independently

• 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 communicate effectively in English (grammar, spelling, writing, and verbal skills)

• Must have basic computer and keyboarding skills: Word, Excel and Outlook required

• Must maintain confidentiality when dealing with medical information

Experience using a 10-key adding machine preferred

 

• Medical software experience preferred

• Basic knowledge of work injury laws preferred

Basic knowledge of CPT and ICD-9 codes preferred

 

• Knowledge of medical terminology, its spelling and abbreviations preferred

• Ability to communicate in Spanish helpful

1. Alphabetizes and files

 

2. Creates new files as needed

3. Prepares letters and bills for mailing (copying, stapling, folding and stuffing)

4. Requests information from clinics

5. Pulls, photocopies and organizes records (charts, Explanation of Benefits (EOBs) and Maximum Medical Improvement Reports (MMIs), etc.) as requested

6. Organizes and faxes materials

7. Assists with insurance phone calls

8. Maintains files

9. Answers phones as needed

10. Assists with data entry

 

ESSENTIAL JOB FUNCTIONS AND DUTIES:

CLERICAL DUTIES

 

1. Makes phone calls to insurance carriers and employers to check status of outstanding Workers’ Comp balances at 30 days past Date of Service (DOS)

2. Documents calls on patient encounter in computer

3. Notifies Work Comp Collector (WCC) when an employer’s billing information has changed

4. Resubmits billing when necessary and creates task to verify receipt

5. Prints Health Insurance Claim Form (HCFAs) and verifies all required fields are completed

6. Attaches copies of charts and work status to HCFAs

7. Stamps HCFA with appropriate stamps

8. If Subscriber Private Pay (SPP) follows the SPP process below

9. Folds documents and inserts in window envelopes

 

10. Once receipt is verified or after 2 unsuccessful attempts to contact, reassign existing task to assigned Work Comp Account Representative (WCAR) or WCC

1. Creates Benefit Review Conference (BRC) and Contested Case Hearings (CCH) files

a. Prints medical records

b. Completes cover letter

c. Labels folder

d. Makes required copies

e. Creates task to follow-up on BRC status in two weeks

f. Provides Occupational Billing Manager (OBM) the BRC or CCH request details

2. Prepares and mails required copies

3. Maintains BRC and CCH files a. Files all correspondence in appropriate file

b. Mails out bills relating to BRC or CCH agreements

c. Makes notes of action on document sheets and in computer

d. Updates task with BRC or CCH scheduled date/time and assign to responsible WCC

e. Sends group email to all collectors and supervisors of BRC or CCH schedule 4. Documents all DWC correspondence 1. Submitting HCFAs with the SPP Letter a. Updates tasks as responses are received or as they come due

b. If response not received by task due date

c. Calls employer for status of letter

d. Requests letter to be sent back to designated fax number

e. When response is received 1) Updates all applicable encounters according to letter

WORKERS’ COMPENSATION FOLLOW-UP DUTIES -Call reports printed on the 1st and 15th of every month

WORKERS’ COMP BRC AND CCH DUTIES

a. Mails certified to patient, DWC, Office of Injured Employee Counsel (OIEC) and insurance

b. Attaches certified return receipts to envelopes

c. Places receipts in appropriate folder

d. Places return receipts in appropriate folder

a. If correspondence requires any type of action, gives to WCC to complete

b. Processes and sends cancellation letters for BRCs/CCHs

c. Files all correspondence related to BRCs/CCHs in file

d. Updates BRC/CCH schedule book

WORKERS’ COMP SUBSCRIBER PRIVATE PAY DUTIES – INITIAL BILLING AND FOLLOW-UP

a. Uses the approved SPP Letter

b. Enters a current date

c. Enters employer address to include an “Attn:” line

d. Enters Patient’s name and date of injury (DOI) in the reference section

e. Enters the designated WCA’s fax number for the letter to be returned to

f. Prints and staples letter to each applicable HCFA

2. Creates a follow up task with a due date of one day after the due date on the letter

a. Updates tasks as responses are received or as they come due

b. If response not received by task due date

c. Calls employer for status of letter

d. Requests letter to be sent back to designated fax number

e. When response is received 1) Updates all applicable encounters according to letter

2) If employer selects send claim to insurance, updates all applicable encounters, submits to insurance and updates task to follow up with insurance in 2 weeks to verify that the claim has been received

f. If employer does not respond to first request

g. If employer will be responsible for claims

1) Assigns task to WCC to follow up in 2 weeks

1. Distributes paperwork

2. Mail returned for wrong employer address

a. Contacts employer to verify address

b. Requests fax number for claims to be faxed to

c. If address is incorrect, assigns a task to the designated WCC to update address in File Maintenance

3. Mail returned for wrong insurance address

a. Contacts the employer to verify insurance

b. Requests claim be established and to call back with a claim number

c. Creates task to follow up in two business days

d. If no response after two attempts assigns task to the WCC

 

1) Makes second attempt to call employer

2) If employer does not respond within 24 hours submits claims to insurance

3) Updates task to follow up with insurance in two weeks to verify that the claim has been received

WORKERS’ COMPENSATION CORRESPONDENCE DUTIES

Sort, Distribute and Process Correspondence

a. Sorts and distributes correspondence, separating by WCC responsibility

b. Distributes or files in-coming correspondence for BRCs and CCHs

a. Contacts insurance for billing address

b. Requests fax number for claims to be faxed to

c. If address is incorrect, assigns a task to the designated WCC to update address in File Maintenance

4. Mail returned for First Report of Injury

OTHER

1. Interacts with staff members professionally

2. Follows company policies and procedures (time and attendance, appropriate attire, etc)

3. Correctly use office equipment

4. Works safely

5. Other duties as assigned

6. Must be punctual and reliable in attendance

 

Essential Job Functions & Duties:

WORK CONDITIONS AND RISKS: Work is indoors in well lighted, and seasonally heated and cooled business office. Job hazards are estimated to be minimal (low risk). Potential risks exist from accidents while using routine office equipment.

PHYSICAL REQUIREMENTS: Position occasionally needs to lift (30-50lbs) boxes from chest height to floor to chest height. Opening and closing (approximately 20lbs) drawers. Repetitive motion consists of extended periods of upper body and upper limb movements (arms, hands, and wrists). Able to climb a ladder and work at heights removing and storing boxes. Good vision, good hearing, and clear speech required (correctable). Prolong use of phone and computer.

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

CUSTOMER SERVICE SKILLS:

 

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