Primary Responsibilities
1. Patient Communication & Appointment Coordination
- Answer incoming phone calls directed by the auto-attendant or front desk.
- Check and return voicemails promptly.
- Monitor and respond to emails consistently.
- Make patient appointments, especially new patients referred by trusted sources.
- Provide updates and guidance to patients regarding authorizations, procedures, and expectations.
2. Insurance & Legal Documentation
- Ensure complete insurance and attorney information is gathered for all new patients.
- Enter insurance and attorney details for past patients as information becomes available.
- Prepare liens for personal injury (PI) cases at the onset of treatment.
- Obtain authorizations for physical therapy (PT) and other treatments.
- Appeal denied authorizations by gathering necessary documentation and coordinating with the doctor.
- Work on claim denials (identify reason, gather support, contact insurance).
- Facilitate Peer-to-Peer discussions between physicians and insurance reviewers as needed.
- Send itemized bills in response to medical records requests.
3. Clinic Preparation & Follow-Up
- Review the schedule for the following day to ensure readiness.
- Verify patient details for:
- WMC (Workers' Comp – Accepted)
- LWC (Litigated/Non-Accepted Workers' Comp)
- PI (Personal Injury)
- DOL (Department of Labor)
- Confirm or obtain missing information:
- Case status (Open/Accepted)
- Accepted body part(s)
- Adjuster and Nurse Case Manager (NCM) contact information
- Utilization Review department contacts
- Billing addresses
- Attorney information, if applicable
- Print updated FCS (patient summary)
Expectations & Qualifications
- Detail-Oriented: Ability to manage and organize detailed records and retrace steps when needed.
- Strong Communicator: Act as the central coordinator between doctors, adjusters, nurse case managers, attorneys, physical therapists, and internal staff.
- Patient Interaction: Explain procedures, system processes, and authorization updates professionally and clearly.
- Relationship Building: Maintain proactive communication with referring doctors and facilities to support ongoing patient referrals.
- Professionalism: Display patience, courtesy, and a high level of professionalism at all times.
- Task Management: Maintain an up-to-date task list to ensure deadlines are met and follow-ups are completed.
Additional Responsibilities
- Participate in special projects or other duties as assigned by supervisors or management.
