Workers Comp Authorization Coordinator - 133351

Under minimal supervision, the Worker's Compensation Coordinator acts as liaison between physicians, adjusters, nurse case managers and employers to expedite delivery of medical care for workers compensation patients. Provides case coordination for WC patients; provides QA review of forms and of medical reports for completeness and accuracy to ensure they meet ACOEM guidelines; assists clinicians with preparation of Permanent & Stationary reports according to AMA guidelines. Secures authorization and process referrals for specialty care and diagnostic testing requested by COEM providers. Serves as a resource for staff/faculty regarding WC laws and procedures. Supports/trouble shoots departmental IT systems; Serves as a Super user/Administrator for Ishare site; acts as an IT resource for departmental staff. Develops and implements EMR forms. Requires strong understanding of workers' compensation system, laws and procedures. Demonstrated skill using MS Office and Adobe Acrobat. Provides staff training as required. Job standards are to be performed at the EXPERT level.

• Six of related experience, education/training, OR a Bachelor's degree in business, healthcare administration, or related area plus two years of relevant healthcare experience.

• Demonstrated ability to analyze and interpret policies, rules, laws and regulations by performing case management and analyzing and reviewing large quantities of medical reports and extracting pertinent information such as diagnosis, work status, estimated and transitional return to work, and treatment plans.

• Prior experience with and knowledge of Workers' Compensation guidelines and California law.

• Experience working with insurance carriers, third party administrators, referral sources and outside employers regarding Workers' Compensation services.

• Demonstrated ability to maintain confidentiality.

• Demonstrated communication skills, both verbal and written, including knowledge of proper business formats, grammar, spelling and punctuation.

• Demonstrated customer service skills with the ability to answer in-person and written requests, and telephone calls and impart accurate and current information in a courteous, friendly and professional manner.

• Skill to use word processing, database, spreadsheet, e-mail, and web-based software. Skill to use Microsoft Office Suite, including Word, Excel, Access, PowerPoint and other software, and web-based functions.

• Demonstrated knowledge of federal HIPAA regulations and state health insurance laws.

• Knowledge of and experience with University Workers' Compensation policies and procedures

• Knowledge of medical and insurance terminology.

• Experience using IFIS and EPIC.

• Knowledge of insurance claims processing and interpreting explanation of benefits.

• Experience using Systoc EMR.

• Must be able to provide transportation between Thornton Hospital, UCSDMC, COEM and customer sites.

• Variable hours; overtime may be required.

• Must be able to work various hours and locations based on business needs.