Work Comp Specialist

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: 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: Reports directly to the PFS Manager.

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.