Overview: To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Under the direction of the Director, Workers Compensation, performs diversified administrative duties of a complex and highly confidential manner in a variety of duties in the administration of Yale New Haven Health System Workers' Compensation Program. Assists with completion and monitoring of state mandated workers? compensation communication and reporting. Monitors and tracks FML status and communicates changes to HR Connect team. Complies information on workers? compensation hearing notifications, Monitor State of CT Judicial website for third party liens and monitors until the lien period is exhausted. Tracks and monitors utilization review requests and appeals, ensure all deadlines are met, track and communicate appeals. Prepares in quarterly reporting to the Workers Compensations Commission of appeals and/or decisions made by the Medical Care Plan CEO. Tracks all claims work status for lost time and/or restricted (modified) duty assignments. Prepares and assists with director with excess reports, tracking and reporting of recoveries. Monitors and tracks MSA submissions, stipulation and final and full stipulation deadlines. Tracks and monitors receipt of excess or second injury fund reimbursements. Ensure recoveries are accurate for monetary amount and deposit into appropriate financial organizational accounts. Assists and maintains the Medical Care Plan directory. Sends new provider agreements and appropriate paperwork and tracks receipt. Updates medical care plan directories and notifies all pertinent parties of updated information/changes. Reports and changes/deletions to the Workers Compensation Commission on a quarterly basis. Monitors the trial period for possible providers and ensures compliance for invite into the Plan. Effectively communicates with claimants, departments and external sources to facilitate the workers compensation process. . Responds to routine department and workers' compensation inquiries. Maintains confidential workers' compensation files and provides general office support. Utilizes workers' compensation computer software application to perform data entry of claim information and correspondence. Ensures integrity of data entered into workers' compensation software application through compliance with department policies and procedures. All functions are performed in accordance with established departmental and organizational policies and procedures. Demonstrates and role models outstanding customer service and the key behaviors outlined in the Hospital's Core Success Factors in all interactions. EEO/AA/Disability/Veteran.

EEO/AA/Disability/Veteran Responsibilities:

1. Performs administrative duties to ensure the efficient operation of the Workers? Compensation Department.
1.1 Schedules appointments, meetings or other requests as necessary, ensures meeting participants are notified within an acceptable time frame. Ensures all pertinent information is sent beforehand or distributed at the time of the meeting.
2. Assists adjusters and director with workers compensation claim handling and processing
2.1 Initiates and prepares the workers'' compensation informational packet with appropriate related workers' compensation materials, polices and instructions. Ensures all required paperwork is returned and completed thoroughly and correctly. Scans and documents the information into the workers' compensation database as legal record/information.
3. Assist, track, and monitoring workers' compensation claims and other pertinent information
3.1 Monitor the State of Ct Judicial website track third party claims for possible liens. Communicate to the adjuster/director or legal counsel if a civil case has been filed.
4. Assist in the maintaining/updating workers' compensation procedural processes, self-insurance certificates, medical care provider directory, and any other communications.
4.1 Maintain, update and distribute the YNHHS Workers' Compensation Medical Care Plan Directory to HR Connect, Occupational Health and Wellness Departments and any other departments. Prepare a quarterly report to the Workers? Compensation Commission of deletions/additions or changes to the Plan.
5. Provides general office support and functions as the primary record keeper, maintains a well-organized file for claimant, vendor and other associated information.
5.1 Maintains claimant, vendor and other required records and ensures that they are filed following department procedures

Qualifications:

EDUCATION

Bachelor's degree or equivalent. Post high school degree or courses in business, legal, insurance billing and medical terminology preferred.

EXPERIENCE

Three to two years of general office work experience required. Experience and knowledge of workers' compensation regulations and requirements, FMLA, disability programs and claims administration, and billing/processing is preferred.

SPECIAL SKILLS

Excellent written and verbal communication skills; excellent interpersonal and organizational skills; with attention to detail. Ability to communicate effectively with all levels of the organization. Ability to think logically in following instructions and procedures. Ability to communicate in a professional manner via email or phone. Excellent keyboarding skills; strong working knowledge of Microsoft Windows operating system, Intermediate skills in Microsoft Word and Excel and ability to learn specific database applications. Knowledge of department and organizational policies and procedures. Knowledge of math and basic accounting

PHYSICAL DEMAND

Primarily sedentary work sitting within typical office setting without exposure to adverse environmental conditions . Requires occasional ability to lift, push and pull objects such as files and office supplies up to 30 pounds and /or continuously up to 10 pounds; and occasional moving about on foot to accomplish tasks, walking long distances or moving from one work site to another. Continuous use of telephones requiring ability to hear and speak to convey detailed or important instructions accurately, loudly or quickly; and continuous use of computer and other office equipment requiring fingering and excellent keyboarding skills.