What your day may look like:

You start off your day checking your "to-do" list: You may receive tasks from several different Case Managers.  You will prioritize your tasks by due date and urgency. The Case Management Supervisor and the Case Managers you assist and are always available for clarification, should you need it.

Once you complete a task you will assign a follow up task back to the Case Manager. Similar to tennis, you and the Case Manager will pass the “ball” back and forth to coordinate care for each injured worker. In the beginning, you are assigned simple tasks such as calling to confirm appointments, calling to collect reports, and drafting case management reports. As you progress, you are assigned more complicated tasks such as researching providers, arranging transportation, reviewing records, and special projects.

If you are further along the track to transition into a case management position if that is of interest to you, you are more involved in communicating with all parties. You may shadow a Case Manager attending appointments and type up an after-appointment summary for the Case Manager's review. Once you are ready to transition to a Case Manager role, you can start covering appointments for the Case Managers and eventually start building your own caseload.

What your day may look like:

You receive referrals/cases from multiple sources.  On most cases you work directly with a claims professional. They collaborate and strategize with you to move each claim forward.

You are able to organize each day with our web-based, proprietary case management system. With  a click of a button you know what tasks you have on-hand for the day. Part of your day may be used to travel to physician appointments to meet with the physician and the injured worker.  In most instances, time spent in the waiting room is valuable time with the injured worker to check in and discuss their injury and return to work plan. After you leave the office, you may schedule a follow up appointment for the injured worker, and provide an update to the Claims Examiner.

 Documents are uploaded into our system to the appropriate claim.  You will create tasks in our system for each case, allowing them to stay on track. This provides a consistent approach to case management for each case. You can email updates directly from the case in our system - a paper trail without the actual paper.

Another part of the day may include returning phone calls, follow up with physician offices on medical reports, write a letter to an attorney, or research a new physician in the MPN. Utilizing your smart phone, tablet, or computer, you enter all your notes and billing into the web-based system at the end of each day.

CMs are an advocate for the injured worker:  you educate them about their injury and how to navigate through the workers’ compensation system. You collaborate with all individuals involved in the claim to assist in meeting the overall goal... recovery!  Allowing them to return to work in the safest and most cost effective manner possible.

ADMINISTRATIVE ASSISTANTS

Our Administrative Assistant positions are  great entry level opportunities for a variety of our departments. These positions help our departments run smoothly by doing clerical and general office duties. An employee who comes in as an Administrative Assistant is often promoted to a new position within the same department or even in other departments within a few years. If you are interested in the administrative side of healthcare, this is a great place to start!

What your day may look like:

As an Administrative Assistant at EK Health, you will have a variety of tasks to complete every day.  You must be able to prioritize tasks efficiently as they come across your desk. Since the work may often be determined by the department, you responsibilities may vary. 

Your duties throughout the day may include answering incoming calls and directing them to the appropriate party, scheduling travel, scheduling WebEx meetings, sorting and distributing mail, preparing and sending invoices, and processing any returned mail that may come in. You may be in charge of maintaining and communicating time off schedules for employees and contractors, making availability of staff clear for work assignments in multiple departments. On a semi-monthly basis, you may perform an office supply inventory check and order supplies for employees in multiple office locations. Our management staff will also assign you special projects as they come up.

UTILIZATION REVIEW (UR)

What your day may look like:

As a Utilization Review Health Care Professional (UR HCP), it is extremely important for you to be to be independent and self-motivated to complete this time-sensitive work from home.  You will prioritize your work based on deadlines and urgency. You will review medical records for the injured worker, review the treatment being requested, and compile pertinent medical information to review for medical appropriateness.  Sometimes you confer with the physician reviewers, and always adhere to evidence-based guidelines (MTUS, ODG, and ACOEM).

Documentation is key for all communications and any additional information obtained related to the treatment request. You will have a weekly conference call with the entire UR team to discuss changes in workers’ compensation regulations, how to improve the quality of the UR product, as well as specific requirements of our customers. The UR department works together towards a common goal: to get appropriate treatment for the injured worker without unnecessary delays. 

What your day may look like:

You will begin by prioritizing your day. First, you will check any aged queries you may have. If there are bills in your aged query you will need to figure out why they are there and note each one. Upon completion of that you will then go into your bill review queue(s) assigned and begin processing bills, beginning with the oldest received date.  As you process you will need to pay close attention to detail so that the bills are being keyed correctly. You will also need to confirm that the correct fee schedules and client rules are being applied.  The accuracy of all of these aspects of reviewing a bill is key. We strive to review all bills correctly based on the information provided to avoid any disputes or reconsiderations. This also reflects positively to our clients. Bill review is a balance between accuracy and speed: It is important that the bills are adjudicated accurately while maintaining the production standards.

You may also be asked to assist in other projects by management. These may include review only, OCR bills, assisting in other queues, training new hires, etc.  A review only is a special request from our client where we review a group of bills that is being disputed for a variety of reasons. We provide a review of these charges, pricing them to the corresponding State Work Comp fee schedule.  The client then uses this information to either settle the dispute or challenge the provider’s dispute in a DWC hearing. OCR bills or Ebills are bills that are submitted to a 3^rd party vendor. This vendor captures the data from the bill and this information is sent to us electronically. This speeds up the processing time as the information from the bill does not require keying. The reviewer needs only to verify and validate the information submitted and review the charges to the appropriate State Fee Schedule.