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About the Role

The WC Coordinator manages and facilitates workers' compensation processes in healthcare and social assistance settings, ensuring timely and accurate claim handling. This role coordinates between employees, providers, carriers, and internal departments, maintaining compliance and supporting employee recovery and return-to-work plans. The coordinator's effective case documentation and communication minimize organizational risk and support operational continuity, contributing to a safe work environment.

Responsibilities

• Prepare and submit requests for authorization for non-surgical treatments to Workers' Compensation carriers.
• Track submitted requests through the review cycle and follow up proactively on pending or delayed determinations.
• Update and resubmit requests as needed based on payor requests for additional information.
• Prepare and submit Level 2 and Level 3 appeals for denied or modified authorizations, including compiling supporting clinical documentation and medical necessity justification.
• Monitor appeal deadlines and ensure timely filing in accordance with WCB timeframes.
• Maintain organized records of appeal status and outcomes.
• Distribute approved authorizations to physical therapy locations and to patients in a timely manner.
• Contact outside medical practices to request and obtain medical records needed to support authorization and appeal submissions.
• Confirm attorney representation on patient claims and maintain up-to-date attorney contact information.
• Prepare and send Liens to attorneys for signature, and track their return.
• Maintain accurate, organized records of all authorization requests, appeals, correspondence, and supporting documentation within the practice management/EHR system.
• Ensure all submissions comply with current NYS Workers' Compensation Board rules, timeframes, and documentation requirements.
• Flag recurring denial trends or payor issues to management.

Requirements

• High school diploma or equivalent.
• Minimum of 2 years experience in workers' compensation administration or related field within healthcare or social assistance industries.
• Strong knowledge of workers' compensation laws, regulations, and claims processing procedures.
• Proficiency in using claims management software and Microsoft Office Suite.
• Excellent communication and organizational skills with the ability to manage multiple cases simultaneously.
• Associate’s degree or higher preferred.
• 1+ years of experience in a medical office, billing, or insurance authorization role.
• Experience with Workers' Compensation authorization/appeal processes strongly preferred (No-Fault experience a plus).
• Highly organized with excellent follow-up skills and the ability to manage a high volume of concurrent requests.
• Proficiency with EHR/practice management systems and Microsoft Office (Excel, Outlook).
• Ability to work independently and meet deadlines in a fast-paced environment.

Skills

• Strong organizational skills to track and manage multiple workers' compensation cases efficiently.
• Effective communication skills for coordinating between injured employees, medical providers, insurance carriers, and internal teams.
• Analytical skills to review case details, interpret regulations, and prepare accurate reports.
• Proficiency with claims management software and Microsoft Office tools.
• Problem-solving skills to address challenges proactively and facilitate timely resolutions.

Experience Level

• Minimum of 2 years experience in workers' compensation administration or related field
• 1+ years of experience in a medical office, billing, or insurance authorization role

Education Level

• High school diploma or equivalent
• Associate’s degree or higher preferred

Equal Opportunity

• We are proud to be an equal opportunity workplace and an affirmative action employer. As such, individuals are recruited, hired, assigned, and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic.
• Please note we participate in E-Verify and will provide the federal government with your I-9 Form information to confirm that you are authorized to work in the United States.