Responsible for new business development, negotiating contractual agreements with large self-insured, WC carriers, and Third Party Administrators. Educate prospective clients with regards to our cost containment solutions. Attend and exhibit, at various industry trade shows, seminars, conferences, host PCS marketing events. Provide account management services for large PCS accounts. Provide on-site implementation of PCS services for new clients.
Creates/maintains workers’ comp panels and account specific instructions. Review benefits of utilizing PCS services at time of account implementations. Insures panel providers adhere to predetermined protocols.
Schedules all initial appointments for injured associates with panel providers and PCS PT/MRI Network facilities.
Acts as liaison between insurance carrier, employer, and treating provider. Schedules all specialist appointments with panel providers, obtains work status reports, and forwards to all necessary parties.
Responsible for PT/MRI network appointment scheduling, verification of the insurance claim, attendance verification, provider network credentialing, and provider outcomes by monitoring utilization in accordance with industry standard guidelines.
Responsible for developing and maintaining the physical therapy and imaging networks. Works in conjunction with the accounting department to resolve any PCS network provider compliance and billing issues that may arise.
Responsible for processing all Premier Comp Network billing from our physical therapy and diagnostic networks.
The Accounting Department is responsible for all Premier Comp Accounts Receivables and Payables which includes payment to our contracted network providers.
Reprices medical bills in accordance with the workers’ compensation regulations/fee schedule and provides insurers and/or employers with an Explanation of Reimbursement (EOR) to forward to the provider when the insurer and/or employer issues payment. The staff also reviews the medical documentation to ensure that it supports the billing and reimbursement of the charges on the medical bill.