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.

If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.

UC San Diego is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California's Affirmative Action Policy please visit: https://policy.ucop.edu/doc/4010393/PPSM-20
For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

a. "Misconduct" means any violation of the policies or laws governing conduct at the applicant's previous place of employment, including, but not limited to, violations of policies or laws prohibiting sexual harassment, sexual assault, or other forms of harassment, discrimination, dishonesty, or unethical conduct, as defined by the employer. For reference, below are UC's policies addressing some forms of misconduct:

• UC Sexual Violence and Sexual Harassment Policy
• UC Anti-Discrimination Policy
• Abusive Conduct in the Workplace