- Career Level
- Not Specified
York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.
- Provides administrative support to the ADR Unit for medical disputes that are processed through CareWorks medical dispute resolution process.
- Assists with preparation of medical claim information to be sent to BWC for the next level of the process.
- Completes preparation of the ADR file for physician review: prepares dispute issue for the physician; ensures all claim and medical issues are clarified; completes data entry into ADR db, CWMM and BWC systems as appropriate; determines appropriate physician type for the appeal; monitors workload to ensure timely resolution of work; assists with inquiries concerning disputes;
- Completes the back-ending process: data entry of ADR db and BWC systems; performs quality review of physician reports; develops ADR letters and BWC orders; updates case management notes; faxes ADR outcome to BWC; reviews BWC and IC ADR orders and documents in ADR db and CWMM;
- Prepares ADR file for ADR IME if applicable; tracks IME process to ensure resolution of report; assists with ensuring vendor invoices are processed for payment;
- Assists with completion of the front-ending process: pulls appeals from the inbound fax image queries; triages inbound appeals; date stamps; enters data into the ADR database; prints screens from the BWC website to ensure claim and diagnosis status, and claim parties are identified; completes internal forms to track timeline; places notes in CWMM regarding receipt of appeal; monitors ADR team email box for messages regarding appeals;
- Assists with organization of medical information, tabbing of ADR files; prints files, or submits request for files to be printed by HIM;
- Maintains confidentiality and protects operations by following established policies and procedures; securing information; refrains from discussing such information with other than designated personnel;
- Addresses ADR related phone calls by: gathering information, answering questions, and providing information via telephone or in writing; resolves problems by identifying issues, clarifying complaints, routing calls to proper personnel, and ensuring follow-up; and
- Improves company effectiveness and efficiency by identifying issues, recommending solutions; conducting, collecting and analyzing feedback; contributes to overall team efforts by achieving established performance standards.
- Excellent communication and organizational skills; good problem solving skills;
- Ability to handle a diverse and ever-changing work environment; good office computer skills including telecommunications and computer software applications.
- Associate or Bachelors Degree, or equivalent experience in workers compensation, health care, insurance, rehabilitation, sports medicine, or claims management.
- Knowledge of medical terminology/documentation, coding, and workers compensation preferred