About this role
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.