Description
JOB PURPOSE OR MISSION: Coordinates, administers and oversees the company's self-insured workers' compensation program. Reviews all workers compensation claims, ensuring compliance with relevant policies, procedures and legislation. Acts as the company's source of expertise in the interpretation and application of workers compensation policies and legislative provisions for the needs for the age population served, as defined in the department's scope of service.
PERFORMANCE CRITERIA
CRITERIA A: Everyday Excellence Values - Employee demonstrates Everyday Excellence values in the day-to-day performance of their job.
PERFORMANCE STANDARDS:
· Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community.
· Takes initiative in living our Everyday Excellence values and vital signs.
· Takes initiative in identifying customer needs before the customer asks.
· Participates in teamwork willingly and with enthusiasm.
· Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.
· Keeps customers informed, answers customer questions and anticipates information needs of customers.
CRITERIA B: Corporate Compliance - Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines, and the GHS Corporate Compliance Guidelines.
PERFORMANCE STANDARDS
· Practices diligence in fulfilling the regulatory and legal requirements of the position and department.
· Maintains accurate and reliable patient/organizational records.
· Maintains professional relationships with appropriate officials; communicates honesty and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.
CRITERIA C: Personal Achievement - Employee demonstrates initiative in achieving work goals and meeting personal objectives.
PERFORMANCE STANDARDS
· Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.
· Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.
· Upholds the ethical standards of the organization.
CRITERIA D: Performance Improvement - Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his/her job performance.
PERFORMANCE STANDARDS
· Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.
· Initiates or redesigns to continuously improve work processes.
· Contributes ideas and suggestions to improve approaches to work processes.
· Willingly participates in organization and/or department quality initiatives.
CRITERIA E: Cost Management - Employee demonstrates effective cost management practices.
PERFORMANCE STANDARDS
· Effectively manages time and resources
· Makes conscious effort to effectively utilize the resources of the organization — material, human, and financial.
· Consistently looks for and uses resource saving processes.
CRITERIA F: Patient & Employee Safety - Employee actively participates in and demonstrates effective patient and employee safety practices.
PERFORMANCE STANDARDS
· Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.
· Employee proactively reports errors, potential errors, injuries or potential injuries.
· Employee demonstrates departmental specific patient and employee safety standards at all times.
· Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.
JOB FUNCTIONS
ESSENTIAL JOB FUNCTIONS include, but are not limited to:
1. Maintains files and computer records on all Employee Reports of Occupational Injury or Disease.
PERFORMANCE STANDARDS:
· Reviews and evaluates all work-related accident reports for completeness and clarity of data.
· Maintains a complete and accessible file of supervisory notes, medical reports, medical payments, weekly compensation payments, and any other pertinent information related to each employee report.
· Screens individual claims for eligibility for workers' compensation benefits.
· Ensures that all legal and procedural requirements are met for the processing of claims, in order to meet proper and timely payment to employees and medical providers.
· Maintains a computer log on all work-related accident reports.
· Advises on possible solutions for the resolution of claims through settlement, light duty work or rehabilitation.
2. Monitors record keeping compliance, and provides advice on the interpretation and application on workers' compensation policies and procedures.
PERFORMANCE STANDARDS:
· Assures that the proper OSHA records are maintained by all GHS facilities in accordance with established policies.
· Completes Annual Occupational Injuries and Illnesses Survey on a timely basis.
· Assists in training personnel to maintain proper OSHA records.
· Assists in the development and preparation of training materials on workers' compensation for managers.
· Actively participates in the BRGMC Environment of Care (EOC) committee and monitors the EOC committee activities of all GHS facilities.
· Prepares all necessary forms, records and documentation, to include statistical analyses and reports, for all claims.
· Makes recommendations for reducing the frequency and severity of losses through the use of the workers' compensation database and other claims data reports.
3. Provides liaison with attorneys, external agencies and regulatory bodies in the administration of claims and in the care and disposition of claimants.
PERFORMANCE STANDARDS:
· Interacts with GHS's attorneys in the preparation of material for response to complaints filed with the Office of Workers' Compensation and pending legal actions.
· Interacts with the insurance company for the timely reporting of claims information to the reinsurance carrier.
· Communicates and interacts with medical professionals, support agencies and others to monitor and assess the progress of rehabilitation efforts, and to facilitate either return to work or, placement into appropriate positions within or outside the company.
· Monitors individuals that have been determined medically disabled, as assigned or appropriate.
4. Performs all other duties as assigned.
HIPAA REQUIREMENTS:
Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to Job Position including but not limited to: Paper and electronic medical records without limitation, employee health records, patient demographics, lab, radiology and films results, surgery/appointment schedules, medical records related to quality data, patient financial and 3rd party billing information, patients related complaints, information related to patient location, patients religious beliefs, employee prescriptions and/or investigatory information.
SAFETY REQUIREMENTS:
Maintains knowledge of and adherence to all applicable safety practices appropriate to Job Position including but not limited to: Incident reporting, handles wastes, sharps, and linens, exposure control plans, hand washing, and environment of care.
Requirements
EXPERIENCE REQUIREMENTS
Two years' experience in workers' compensation administration.
Experience with a self-insured workers' compensation plan highly preferred.
EDUCATIONAL REQUIREMENTS
Bachelor's degree in business or related area preferred.
SPECIAL SKILL, LICENSE AND KNOWLEDGE REQUIREMENTS
Excellent computer skills. Knowledge of applicable workers' compensation legislation, standards, policies and procedures. Ability to use independent judgment and to manage and impart confidential information.
Strong interpersonal and communications skills and the ability to work effectively with a wide range of constituencies. Knowledge of process requirements of administrative hearings and litigation. Skill in implementing return-to-work, modified duty program. Records maintenance skills.
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