Workers' Compensation Manager

We are an orthopaedic practice looking for a Workers' Compensation Manager to join our team. We believe in going above and beyond, and feel that there is no nobler pursuit than that of caring for others and helping to improve their quality of life. We hope you’ll join us on our mission!

GENERAL SUMMARY OF DUTIES: The Workers' Compensation (WC) Manager is a critical leadership position responsible for overseeing and coordinating all aspects of the workers' compensation program within a small to mid-sized orthopedic practice. This role ensures accurate and timely processing of claims, manages communication between internal staff and external stakeholders, and maintains compliance with state and federal WC regulations. The Manager directly supervises a small team and serves as the primary liaison for employers, insurance carriers, adjusters, case managers, attorneys, and injured employees throughout the care and claims process. The role also encompasses developing and implementing marketing strategies to promote and grow ROSI's workers' compensation revenue, including engaging local businesses to partner with ROSI for the treatment of orthopedic work-related injuries.

ESSENTIAL FUNCTIONS:

1. Oversee the daily operations of the workers' compensation department, ensuring efficient workflow and timely completion of all WC-related tasks.

2. Directly supervise, train, and develop a small team of Workers' Compensation Coordinators; conduct regular performance evaluations, establish goals, and provide ongoing feedback and coaching.

3. Develop, implement, and maintain WC policies, procedures, and workflows aligned with orthopedic specialty needs and applicable state and federal regulatory requirements.

4. Coordinate staffing needs, workload distribution, and cross-training to ensure consistent department coverage and operational continuity.

5. Manage case verification, body part/injury documentation, and approved diagnosis codes to support accurate billing and claims processing.

6. Serve as the primary liaison for employers, insurance carriers, claims adjusters, case managers, and attorneys involved in patient care and claims resolution, ensuring timely and professional communication across all active cases.

7. Coordinate with providers, Ancillary Teams, and other medical professionals to ensure the WC schedule is maximized and care is delivered efficiently.

8. Obtain approvals from adjusters when MRIs, DME, or EMGs are ordered, via email or fax. For DOL insurance, enter orders into the OWCP portal for authorization.

9. Scrub schedules to identify scheduling errors and ensure accurate reporting and proper billing.

10. Coordinate DOL Retro Authorizations; utilize the WC fee schedule to identify coverage, answer WC billing-related questions, and support the team in resolving authorization issues.

11. Assist the WC team with workers' compensation registration and scheduling processes.

12. Assist the WC team with incoming calls from WC patients, adjusters, nurse case managers, and staff.

13. Assist with surgery/procedure authorizations as needed.

14. Send outside referrals for authorization to approved facilities; fax encounter notes, work status forms, and orders to the assigned adjuster and nurse case manager.

15. Develop and implement marketing strategies to attract new employer clients, retain existing partners, and increase overall market presence, including email campaigns and social media outreach.

16. Engage with the company's marketing contact to develop and review materials that educate potential clients about ROSI's services and capabilities.

17. Network and stay current on workers' compensation industry regulations, laws, and best practices.

18. Provide data reports and analytics for workers' compensation program metrics.

19. Oversee the IME (Independent Medical Exam) program by coordinating exams and treatment with attorneys, case managers, and providers.

20. Other duties deemed necessary by management.

EDUCATION:

Bachelor’s Degree in Healthcare or Business Administration preferred (or equivalent experience)

EXPERIENCE:

Five (5) years required managing workers’ compensation in healthcare and

Two (2) years required in Orthopedics

REQUIREMENTS:

CPC certification preferred

KNOWLEDGE:

1. Knowledge of insurance guidelines and workers' compensation laws, regulations, and procedures at the state and federal level.

2. Knowledge to assist others with navigating the workers' compensation process and answering related questions.

3. Knowledge of medical terminology, medical coding, medical billing, and insurance guidelines, including CMS.

4. Knowledge to actively manage individual workers' compensation cases, track progress, ensure timely treatment, and coordinate with other healthcare professionals.

5. Knowledge to train, develop, and supervise a team of workers' comp coordinators to successfully manage departmental operations within an orthopedic practice.

6. Knowledge of OSHA and HIPAA Rules and Regulations.

7. Knowledge of medical billing and CPT-4, ICD-10, and HCPCS coding systems.

8. Proficiency in Microsoft Office applications, including Outlook, Word, Excel, and Teams.

9. Proficiency with Department of Labor provider portal

SKILLS:

1. Skill in maintaining accurate records of patient information, treatment plans, and communication logs.

2. Skill in entering data into computer systems and managing databases.

3. Skill in prioritizing workload for optimum performance.

4. Skill in selecting and using training and educational methods appropriate for the situation when learning or teaching.

5. Skill in understanding the implications of new information for both current and future problem-solving and decision-making.

6. Skill in tact and diplomacy in interpersonal interactions.

7. Skill in time management, problem solving, and critical thinking.

ABILITIES:

1. Ability to communicate clearly in person and by phone, and to establish and maintain cooperative relationships with patients, families, physicians, staff, employers, adjusters, attorneys, and other stakeholders.

2. Ability to organize and prioritize tasks effectively.

3. Ability to read, understand, and follow oral and/or written instructions.

4. Ability to manage, lead, and communicate effectively with Workers' Compensation Coordinator staff.

5. Ability to remain calm and exhibit tact in stressful or delicate situations.

6. Ability to participate effectively as a team member by supporting change, decisions, and other staff, and by managing conflict appropriately.

7. Ability to maintain confidential and sensitive information in accordance with HIPAA and applicable regulations.

8. Ability to engage with HR departments, safety managers, claims adjusters, case managers, and attorneys to market the company's services and support case resolution

ENVIRONMENTAL WORKING CONDITIONS:

Office setting is well ventilated and well lit. Occasional local travel.

PHYSICAL/MENTAL DEMANDS:

Sitting for approximately 8 hours/day. May require some light, local travel to conferences, medical offices and other facilities to discuss business opportunities for ROSI. Requires eye-hand coordination, finger dexterity. Vision must be corrected to 20/20 and hearing must be normal range. Must be able to view computer screens for long periods. Occasional stress related workload, patients with problems, or providers with problems and from dealing with upset patients, emergent situations or call volume. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as need evolve.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• Are you proficient in using any Electronic Medical Record (EMR) systems? If so, which ones?
• What is your earliest start date if offered the position?
• Do you have Certified Workers’ Compensation Professional (CWCP) designation in the state of Georgia?
• Do you have workers' compensation experience with Georgia Department of Labor provider portal?

Experience:

• Orthopedics: 2 years (Preferred)
• Workers' compensation: 2 years (Required)

Work Location: In person