Job Details

Position Summary

The Rehab Patient Access Representative / Referral & Workers' Compensation Coordinator is responsible for managing rehabilitation referrals, patient chart creation, workers' compensation and third-party liability authorizations, orthotics scheduling, front desk float coverage, and supporting insurance verification across all rehabilitation clinic locations.

This role ensures timely scheduling, accurate documentation, treatment authorization compliance, and effective communication with physicians, adjusters, case managers, attorneys, patients, and rehabilitation staff. The position supports organizational goals related to quality patient care, patient satisfaction, regulatory compliance, and operational efficiency.

The job holder must demonstrate and maintain current competencies for the position.

Essential Duties & Responsibilities

Referral Coordination, Chart Management & Insurance Verification

• Receive and manage rehabilitation referrals from LOS and external physicians.
• Initiate and complete patient chart creation in the EMR system upon receipt of referral.
• Verify and enter accurate patient demographic and insurance information.
• Obtain required documentation, prior authorizations, and referral details prior to scheduling.
• Support the insurance verification team by checking patient insurance benefits as needed.
• Communicate with physician offices and rehabilitation staff to clarify referral requests and treatment directives.
• Maintain a goal of scheduling rehabilitation appointments within one (1) week of referral receipt.
• Contact patients to coordinate and schedule appointments, providing clear instructions and expectations.
• Track referral status from initiation through scheduling and treatment compliance.
• Communicate effectively with outside rehabilitation providers when managing external referrals.
• Ensure all referral activity and patient interactions are accurately documented in the EMR.
• Escalate scheduling or authorization barriers to the Rehabilitation Director or staff therapist as appropriate.

Workers' Compensation & Third-Party Liability Coordination

• Prepare and submit Requests for Treatment authorization to workers' compensation carriers (state and federal claims) via fax, email, and online portals.
• Prepare and submit 1010A and 1009 forms when necessary and justified.
• Correspond with workers' compensation adjusters, nurse case managers, and attorneys to ensure timely responses in accordance with established guidelines.
• Assist with intake and setup of attorney-referred and third-party liability (TPL) patients.
• Verify claim details, occupational insurance coverage, and responsible parties for on-the-job injuries.
• Request and track Letters of Guarantee (LOGs), funding authorizations, and other necessary documentation from attorneys or insurers.
• Schedule appointments and ensure all required documentation is obtained prior to services.
• Maintain tracking logs for:
• New patient workers' compensation and TPL referrals
• Patient visit compliance
• Treatment requests submitted for approval
• Approved and denied treatment requests
• Follow up on pending authorizations and document all communication.
• Ensure proper documentation supports billing, compliance, and regulatory standards for both workers' compensation and third-party liability cases.

Orthotics Responsibilities

• Schedule orthotic evaluation and fitting appointments as ordered by the provider.
• Collect required patient deposits in accordance with organizational financial policies.
• Accurately document deposit collection in the EMR and payment system.

Rehabilitation Check-In / Check-Out Float Coverage

• Serve as rehabilitation front desk float staff on an as-needed basis.
• Provide coverage for planned time off and unexpected absences.
• Perform patient check-in and check-out procedures, including verifying demographics, collecting copayments, and scheduling follow-up appointments.
• Answer incoming rehabilitation phone calls and appropriately route inquiries.
• Maintain consistent customer service standards across all six (6) clinic locations.
• Must be willing and able to travel to and provide coverage at all six (6) rehabilitation clinic locations.

Requirements

Administrative & Reporting Responsibilities

• Operate office equipment including voicemail systems, fax machines, scanners, and copiers.
• Utilize Microsoft-based programs (primarily Excel) and other software applications to prepare reports, invoices, financial statements, letters, case histories, and medical records.
• Maintain spreadsheets and tracking tools for referral, authorization, insurance verification, and compliance monitoring.
• Maintain strict patient confidentiality in accordance with HIPAA standards.

Education

• High school diploma or GED required.

Experience

• Two (2) to three (3) years of medical office or medical billing experience preferred.
• Workers' compensation authorization and third-party liability experience preferred.
• Outpatient rehabilitation experience preferred.
• Experience supporting insurance verification preferred.
• Must demonstrate ability to communicate effectively with physicians, patients, adjusters, nurse case managers, attorneys, and the public.

Knowledge

• Knowledge of physician billing processes, including 1010A and 1009 forms.
• Knowledge of workers' compensation and third-party liability authorization guidelines (state and federal).
• Knowledge of referral processes, insurance verification, and patient eligibility requirements.
• Knowledge of rehabilitation terminology.
• Advanced knowledge of computer systems, EMR software, spreadsheets, and Windows-based programs.
• Knowledge of multi-line phone systems.

Skills

• Strong customer service skills and adherence to organizational code of conduct.
• Proficiency in Microsoft Excel, Word, and Outlook.
• Strong documentation and organizational skills.
• Ability to effectively communicate with internal staff, external referral sources, attorneys, and patients.

Abilities

• Ability to multitask in a fast-paced clinical environment.
• Strong attention to detail and analytical ability.
• Ability to establish and maintain effective working relationships with patients, providers, staff, and legal representatives.
• Ability to work independently and manage multiple priorities.
• Ability to interpret patient demographic and insurance information to determine eligibility.

Environmental / Working Conditions

• Normal office environment.
• Some travel within the community required.

Physical / Mental Demands

• Requires sitting and standing associated with a normal office environment.
• Occasional bending and stretching.
• Manual dexterity required for calculator, keyboard, and office equipment operation.
• Ability to lift up to 25 pounds.
• Occasional kneeling, squatting, and overhead lifting may be required.