Position Summary:
The Medical Administrator coordinates, processes, and tracks medical referrals for injured workers in compliance with Workers’ Compensation regulations. This role ensures timely access to authorized specialty care while maintaining effective communication among healthcare providers, legal case managers, vendors, administrative staff, and management. The department plays a vital role in facilitating appropriate treatment and ensuring all regulatory and payer requirements are consistently met.
Roles and Responsibilities:
1. Receive, review, and process referral requests in accordance with Workers’ Compensation guidelines and payer authorization requirements.
2. Coordinate appointments for authorized referrals.
3. Communicate effectively with treating providers, legal case managers, vendors, admins and management.
4. Track referral status from submission through completion and follow up on pending authorizations or appointments.
5. Maintain accurate and timely documentation in Affirmative Claims Manager.
6. Ensure compliance with state Workers’ Compensation laws, utilization review requirements, and internal policies.
7. Identify and escalate delays, denials, or barriers on referral issues.
8. Understanding the different programs and relationships involved with Affirmative.
9. Learn the Labor Codes and Codes of Regulation pertaining to the department.
10. Verbal and written request to direct supervisor is required for any issues regarding lack of training and development for position.
11. Overtime may be necessary.
12. Assist with special projects and other requests as needed.
13. Must adhere to HIPPA guidelines and maintain current valid HIPPA training certificate.
PHYSICAL REQUIREMENTS:
- Ability to sit for extended periods (up to 8 hours per day).
- Ability to use hands and fingers for typing and handling office equipment.
- Ability to see and read computer screens and printed documents.
- Ability to communicate clearly in person and over the phone.
- Occasional lifting of up to 10–20 pounds (e.g., office supplies).
- Ability to move within the office environment (e.g., walking short distances).
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Preferred Skills:
The Medical Administrative professional must demonstrate strong computer proficiency, including expertise in Microsoft Outlook, Excel, and Word. They should possess excellent organizational and time-management skills to effectively manage a high-volume environment. Clear, professional written and verbal communication skills are essential, along with strong attention to detail and accuracy in documentation and data entry. The role requires the ability to prioritize urgent referrals, manage multiple cases simultaneously, and maintain a strong understanding of and commitment to the company’s philosophies.
Special Notes: This job description is intended to describe the general nature and level of work performed. It is not an exhaustive list of all responsibilities, duties, and skills required. The company reserves the right to modify duties as needed.
Job Type: Full-time
Pay: $19.00 - $24.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Work Location: In person
