Revenue Cycle Workers Compensation Coordinato

Position Summary 

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. 

Key Responsibilities

 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 & Payer 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.

Revenue Cycle & Operations Liaison 

▪ Serve as the primary point of contact between the workers’ compensation billing team and clinic operations for documentation and workflow needs. 

▪ Escalate recurring front-end issues impacting workers’ compensation billing with root-cause analysis and recommended solutions. 

▪ Support alignment between clinical, operational, and billing teams to improve end-to-end workers’ compensation revenue cycle performance. 

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. 

Credentialing & Enrollment Support 

▪ Partner with the outsourced workers’ compensation credentialing and enrollment vendor to ensure providers and clinics are properly enrolled with workers’ compensation payers. 

▪ Track enrollment status, revalidations, and expirations to prevent billing disruptions. 

▪ Coordinate resolution of enrollment-related issues impacting claim processing. 

Required Qualifications 

▪ 2+ years of experience in healthcare operations, revenue cycle coordination, or workers’ compensation workflows, preferably in urgent care or ambulatory settings. 

▪ 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 

▪ Associate or Bachelor’s degree in Healthcare Administration, Business, or related field (or equivalent experience). 

▪ Experience supporting multi-site urgent care organizations. 

▪ Experience working with employers, TPAs, and adjusters. 

▪ Experience with workers’ compensation MPN credentialing or enrollment. 

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 

▪ Office or remote environment; flexibility for onsite work dictated by business needs 

Reporting Relationship 

▪ Reports to the Vice President, Revenue Cycle Services