Wrid Case Manager Jobs

JOB SUMMARY

Coordinates and processes the daily flow of communication and documentation to obtain authorization for treatment or medical procedures for work-related injuries, illnesses or business-related health care.

ESSENTIAL FUNCTIONS OF THE ROLE

• Accurately and promptly prepares all required documentation to comply with TWCC regulations utilizing the OccMed database, prints and mails required forms to all interested parties.* Maintains an accurate working file on all patients with a work related injury/illness in compliance with departmental guidelines.
• Conduct urine drug screens
• WRID Case Manager specific to Round Rock Region additional duties:
• Check patients in and out
• Effectively educates and supports regional clinics about TWCC/DOL rules and regulations, form preparation, referrals, pre-authorizations and use of SMS systems.
• Correct statement errors
• Responds promptly and accurately to requests for patient information in accordance with established policies and procedures or, if unable or unqualified to assist, promptly routes calls to the appropriate party/department.
• Accurately and promptly collects initial demographic patient data from patient and employer prior to scheduling non-emergency work related injury/illness appointments, maintains and updates OccMed database with required data.
• Collects all medical documentation needed to obtain pre-authorization/certification from payers in a timely manner.
• Conduct breath alcohol tests
• Provides problem resolution in a professional and timely manner, researching inaccuracies and initiating corrections or clarifications of workers' compensation information and/or billing.
• VERIFIES INSURANCE COVERAGE FOR WORK RELATED INJURIES/ILLNESSES AND OBTAINS PRE-AUTHORIZATION TO ENSURE TIMELY PATIENT CARE AND PAYMENT FOR SERVICES RENDERED.
• Answers inbound calls
• Reports work status of patient to appropriate parties in a timely manner.
• OBTAINS AUTHORIZATION FOR TREATMENT AND MEDICAL PROCEDURES FROM INSURANCE AGENCIES, THE TEXAS WORKERS' COMPENSATION COMMISSION (TWCC), THE DEPARTMENT OF LABOR (DOL) AND OTHER AGENCIES TO FACILITATE TIMELY PATIENT CARE.
• PROVIDES ADDITIONAL ADMINISTRATIVE SUPPORT TO ENSURE DEPARTMENT EFFICIENCY AND CONTINUITY OF SERVICE.
• Approves and coordinates all initial and follow up appointments in compliance with TWCC or DOL regulations.
• Submit billing corrections
• Attends and participates in WRID quarterly staff meetings.
• Promptly identifies whether patient's employer is a subscriber to the TWCC.
• Accurately enters all registration and billing information into computer system to direct billing to appropriate payer group prior to scheduling patient appointments.
• SERVES AS LEADER AND LIAISON TO REGIONAL CLINICS REGARDING ISSUES OF WORK RELATED INJURY/ILLNESS AND BUSINESS RELATED HEALTH CARE TO ENSURE CONTINUITY OF SERVICE.
• Preferred certification in Breath Alcohol Technicians (BAT) and urine drug screens.
• Assists patients and clients with difficult work related injury/illness management issues in a professional manner.
• Collates data and accurately produces monthly WRID managerial reports.
• Manage referrals
• Acts as liaison between patients, providers and payer groups to ensure relevant patient information is shared with the appropriate parties in a timely and professional manner.

KEY SUCCESS FACTORS

• Microsoft Word or Word Perfect, MS Excel, Power Point, Electronic Mail required.
• Knowledge of medical terminology required.
• Two years of college preferred.
• Knowledge of insurance filing and payment methods, to include Texas Workers' Compensation Rules and Regulations preferred.

BENEFITS

Our competitive benefits package includes the following

• Tuition Reimbursement
• Immediate eligibility for health and welfare benefits
• PTO accrual beginning Day 1
• 401(k) savings plan with dollar-for-dollar match up to 5%

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EXPERIENCE - Less than 1 Year of Experience
• EDUCATION - H.S. Diploma/GED Equivalent