SUMMARY : This is specialized complex technical work involving the evaluation and processing of Workers' Compensation medical and expense billings.
- Evaluates, verifies and updates medical bills on Workers' Compensation Claims for completeness and accuracy to include; the correct diagnosis in relationship to the injury, medical necessity of procedures performed, and the amount to be paid in accordance with either the State or the Preferred Provider Organization (PPO) fee schedule.
- Prepares and files with the State of Florida, Division of Workers' Compensation required reports within the time frame required by law such DWC-13, DWC-10, DWC-21, etc.
- Handles a large volume of telephone calls, interacting with the medical community; claimants; division representatives; attorneys; collection agencies; etc.
- Authorizes medical treatment and prescriptions for minor injuries in the absence of the claims adjusters.
- Performs a variety of tasks in an automated office environment.
- Prepares reports and performs special projects as required.
- Performs related work as required.
KNOWLEDGE, ABILITIES AND SKILLS – REQUIRED AT TIME OF HIRE: ( Applicants are expected to possess the required Knowledge, Abilities, and/or Skills listed below prior to being hired for positions in this job title.)
- Knowledge of Workers' Compensation medical bill analysis or related medical bill analysis in an automated computing environment.
- Knowledge of medical terminology as required for reviewing diagnostic and treatment records and medical bills.
- Ability to analysis and process for payment a large volume of medical bills in accordance with existing reimbursement and/or fee schedules accurately and timely.
- Knowledge of HIPAA's privacy and security requirements as they pertain to protected health care information.
- Ability to work independently and exercise analytical judgment in accordance with established guidelines.
- Ability to handle challenging public relations and employee relations issues and present a positive image in a customer relations setting.
- Ability to express ideas clearly and concisely, both orally and in writing.
- Ability to serve the public and fellow employees with honesty and integrity in full accord with the letter and spirit of BrowardCounty’s Ethics and Conflict of Interest policies.
· Ability to establish and maintain effective working relationships with the general public, co-workers, elected and appointed officials and members of diverse cultural and linguistic backgrounds, regardless of race, color, religion, age, gender, ethnicity, disability, sexual orientation, marital status or political affiliation.
KNOWLEDGE, ABILITIES AND SKILLS – NOT REQUIRED AT TIME OF HIRE BUT EXPECTED TO BE DEVELOPED ON THE JOB: (The following Knowledges, Abilities, and/or Skills listed below, although considered to be required in order to perform the work of this job title, are not required at time of hire.)
- Knowledge of current principles and practices of State of Florida’s Maximum Reimbursement Manual for Workers' Compensation.
- Knowledge of applicable Federal and State Regulations concerning Workers' Compensation.
- Ability to accurately prepare the State Required DWC-13 Claim Cost Report on Lost Time claims and submit within the State required reporting time period.
REQUIRED EXPERIENCE AND TRAINING : Graduation from high school supplemented by specialized training in Workers' Compensation claims, practices and procedures; two (2) years experience in Workers' Compensation claims or related medical billing experience; or any equivalent combination of relevant training and experience.
Bargaining Unit: White Collar
FLSA Status: Non-Exempt
Code of Ethics Certification: No
Work Locations: Risk Management
Class Spec. Estab ./Revised: E10/2004