Work Comp Specialist

Glenwood Medical; Northern, Glenwood Springs (KY, CO); Hybrid; USD 45,000 - 65,000; Full time

Job summary

Glenwood Medical seeks a Workers’ Compensation Coordinator to manage all aspects of WC claims within the practice, acting as a liaison among injured workers, employers, insurers, adjusters, case managers, and healthcare providers to ensure timely authorization, accurate billing, compliance, and efficient resolution.

The role involves maintaining EMR records, verifying coverage, coordinating referrals, and ensuring payer guideline adherence while supporting clinical and administrative staff in WC

Qualifications

• Experience in a medical office setting.
• Knowledge of workers’ compensation processes is a plus.
• Familiarity with CPT and ICD-10 coding is beneficial.

Responsibilities

• Verify workers’ compensation coverage and claim information.
• Document employer, insurer, and adjuster details.
• Secure treatment authorizations and referrals as required.
• Schedule and coordinate appointments for injured workers.
• Maintain WC records in the EMR system.
• Communicate with employers, adjusters, nurses, attorneys, and patients.
• Review documentation for completeness and compliance.
• Process and submit billing and supporting docs.
• Monitor accounts receivable and follow up on denials.
• Research and resolve billing discrepancies and reimbursement issues.
• Ensure compliance with regulations and payer guidelines.
• Track reports and return-to-work documents.
• Prepare management reports on claim activity and trends.
• Assist with training PFS staff.
• Attend classes to enhance knowledge.
• Travel between offices as needed.

Skills

Communication skills

Team player

Attention to detail

HIPAA compliance

Tools

EMR system

Billing software

Job description

TITLE: Worker's Compensation Coordinator

JOB SUMMARY: The Workers’ Compensation Specialist is responsible for managing all aspects of

workers’ compensation claims within the medical practice. This position serves as the liaison

between injured workers, employers, insurance carriers, adjusters, case managers, and healthcare

providers to ensure timely authorization, accurate billing, compliance with state regulations, and

efficient claim resolution.

DUTIES AND RESPONSIBILITIES:

1. Verify workers’ compensation insurance coverage and claim information.
2. Obtain and document employer, insurance carrier, and adjuster information.
3. Secure treatment authorizations and referrals as required.
4. Schedule and coordinate appointments for injured workers.
5. Maintain accurate workers’ compensation records within the electronic medical record (EMR) system.
6. Communicate with employers, adjusters, nurse case managers, attorneys, and patients regarding claim status and treatment plans.
7. Review medical documentation for completeness and compliance with workers’ compensation requirements.
8. Process and submit workers’ compensation billing and supporting documentation.
9. Monitor accounts receivable and follow up on unpaid or denied claims.
10. Research and resolve billing discrepancies, denials, and reimbursement issues.
11. Ensure compliance with state workers’ compensation regulations and payer guidelines.
12. Track physician reports, work status forms, and return-to-work documentation.
13. Prepare reports and provide updates to management regarding claim activity and reimbursement trends.
14. Assist providers and clinical staff with workers’ compensation procedures and documentation requirements.
15. Maintain confidentiality of patient and claim information in accordance with HIPAA regulations.
16. Assists with the training of other PFS staff
17. Attends educational classes when necessary to enhance knowledge base
18. Other duties as assigned by PFS Supervisor or Manager
19. Must be able to travel between offices as requested.

CRITERIA FOR EVALUATION:

CRITERIA FOR EVALUATION: Evaluated on thoroughness in the completion of duties, accuracy, pleasant attitude, dependability, initiative, professional appearance, and the use of tact and mature judgment in relationships with co-workers and patients. Works as a team player with department staff on end-of-month duties.

REPORTING RELATIONSHIP:

REPORTING RELATIONSHIP: Reports directly to the PFS Manager.

SPECIAL QUALIFICATIONS:

SPECIAL QUALIFICATIONS: Previous medical office experience and knowledge of debits and credits preferred. Knowledge of CPT and ICD-10 coding a plus. Must have basic computer skills and some collection experience. Must be able to establish priorities, meet deadlines, work well under pressure. Must be a team player.