Workers Compensation Coordinator

Workers' Compensation Coordinator

The role is responsible for coordinating front-end and operational workflows that support accurate and timely workers' compensation billing in a high-volume urgent care environment. This role partners closely with Clinic Operations, Providers, and the Workers' Compensation billing team to ensure required authorizations, claim numbers, clinical documentation, and enrollments are obtained and completed. This role serves as the primary operational liaison for workers' compensation encounters, helping reduce billing delays, denials, and rework by addressing front-end process gaps.

Workers' Compensation Visit Readiness

• Partner with clinic operations teams to ensure all required workers' compensation information is obtained prior to or at the time of service, including employer details, adjuster information, claim numbers, and authorizations.
• Verify that workers' compensation claim numbers, authorizations, and adjusters' information are documented accurately in the EHR/practice management system before billing.
• Proactively identify missing or incomplete information that could delay billing and initiate resolution.

Employer & Adjuster Outreach

• Contact employers, third-party administrators (TPAs), and adjusters to obtain missing workers' compensation information required for billing.
• Follow up on pending claim numbers, authorization approvals, and documentation requests.
• Maintain clear documentation of outreach efforts and outcomes.

Request for Authorization (RFA) Coordination

• Verify completion and submission of Requests for Authorization (RFAs) in accordance with state and payer-specific workers' compensation requirements.
• Track RFA status and follow up to ensure timely determinations.
• Communicate RFA outcomes to clinic operations, providers, and the workers' compensation billing team.

Clinical Documentation Coordination

• Partner with providers and clinic leadership to ensure required workers' compensation clinical forms and reports are completed accurately and timely.
• Act as a liaison to resolve documentation gaps that may delay claims submission or payment.

Tracking & Process Improvement

• Track and report key metrics such as missing information rates, authorization delays, RFA turnaround times, and documentation completion trends.
• Participate in process improvement initiatives to standardize and optimize workers' compensation intake, documentation, and authorization workflows.
• Assist with training clinic staff on workers' compensation-specific requirements and best practices.

Required Qualifications

• Working knowledge of workers' compensation processes, authorizations, and documentation requirements.
• Strong communication skills and experience working cross-functionally with clinical, operational, and billing teams.
• Familiarity with California workers' compensation regulations and documentation standards.

Preferred Qualifications

• Experience supporting multi-site urgent care organizations.
• Experience working with employers, TPAs, and adjusters.
• Experience in healthcare operations or workers' compensation workflows, preferably in urgent care settings.

Key Competencies

• Strong coordination and follow-up skills
• Attention to detail and documentation accuracy
• Process improvement mindset
• Ability to influence without direct authority
• Effective verbal and written communication
• Collaborative, solutions-oriented approach

Working Conditions

• Maintain a clean and professional appearance at all times
• Office Setting: the noise level is moderate
• The ability to stand and sit for hours at a time, some bending and stooping
• This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management
• Specific vision abilities required by this job include Close vision, Distance vision, Peripheral vision, Depth perception and ability to adjust and focus
• Must be able to read and speak effectively in English

Reporting Relationship

• Reports to the Director of Workers' Compensation