Workers’ Compensation Manager

Role Description

The Workers’ Compensation Manager, RCM is responsible for overseeing Workers’ Compensation revenue cycle operations to ensure timely, accurate, and compliant management of medical claims related to workplace injuries. This role provides leadership and operational oversight for Workers’ Compensation accounts receivable activities, denial management, claim resolution, workflow optimization, and team performance.

The Manager partners closely with clients, employers, adjusters, case managers, healthcare providers, and internal operational teams to improve reimbursement outcomes, reduce aging, resolve claim issues, and maintain compliance with state Workers’ Compensation regulations and payer requirements. This role also supports strategic initiatives focused on operational efficiency, quality improvement, and revenue cycle performance.

Responsibilities

• Leadership & Team Management
  • Provide leadership and oversight to Workers’ Compensation revenue cycle staff, including claim follow-up representatives, denial specialists, and support personnel.
  • Establish performance expectations and monitor productivity, quality, and compliance metrics.
  • Coach, mentor, and develop team members to ensure operational excellence and professional growth.
  • Partner with leadership and offshore support teams to align workflows, staffing models, and operational priorities.
  • Support onboarding, training, and ongoing education related to Workers’ Compensation regulations, payer requirements, and revenue cycle processes.
• Workers' Compensation Revenue Cycle Operations
  • Oversee daily Workers’ Compensation accounts receivable operations across multiple clients and payer groups.
  • Ensure timely follow-up, documentation, escalation, and resolution of outstanding Workers’ Compensation claims.
  • Review and manage inventory prioritization, aging accounts, and workflow assignments.
  • Verify claim accuracy including:
    • Employer information
    • Injury details
    • Claim numbers
    • Authorization requirements
    • State-specific Workers’ Compensation documentation
  • Ensure claims are billed and processed in accordance with payer requirements, client expectations, and state regulations.
• Claim Resolution & Denial Management
  • Oversee resolution of Workers' Compensation-specific claims issues including:
    • Liability disputes
    • Authorization denials
    • Missing employer or carrier information
    • Underpayments and payment delays
    • Documentation deficiencies
  • Serve as an escalation point for complex or high-value Workers’ Compensation accounts.
  • Collaborate with billing, coding, appeals, payment posting, and documentation teams to resolve claim barriers and improve reimbursement outcomes.
  • Monitor denial trends and implement corrective action plans to improve claim recovery and reduce rework.
• Performance Monitoring & Continuous Improvement
  • Monitor key revenue cycle performance metrics including:
    • Days in A/R
    • Aging inventory
    • Productivity and quality compliance
    • Denial rates and recovery performance
    • Resolution turnaround times
  • Analyze trends and identify operational risks, bottlenecks, or workflow inefficiencies.
  • Develop and implement process improvements to optimize throughput, reduce aging, and improve operational performance.
  • Support reporting, audit requests, and operational reviews related to Workers’ Compensation claim activities.
• Client & Cross-Functional Collaboration
  • Partner with client-facing leaders and operational stakeholders to ensure alignment with contractual obligations and client expectations.
  • Participate in client meetings to review aging trends, claim challenges, operational performance, and improvement initiatives.
  • Coordinate with IT, analytics, automation, and operational support teams to improve reporting, workflows, and system efficiencies.
  • Maintain effective communication with adjusters, employers, nurse case managers, and Workers’ Compensation carriers to support claim resolution.
• Compliance, Confidentiality & Training Requirements
  • Maintain strict confidentiality and adhere to all HIPAA regulations governing PHI and PII.
  • Access, store, and transmit documents and data only through approved systems and secure channels.
  • Comply with all TSI audit, privacy, and operational standards related to WC claim activities and documentation handling.
  • Complete all mandatory compliance and training courses set forth by TSI, including annual refresher courses and any client-specific training required for job performance.
  • Ensure all work aligns with internal controls, audit requirements, and client contractual obligations.

Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Finance, or related field preferred.
• 5+ years of experience in Revenue Cycle Management, Workers’ Compensation claims, or healthcare reimbursement operations.
• 2+ years of leadership or supervisory experience preferred.
• Strong knowledge of Workers’ Compensation regulations, payer requirements, denial management, and claim adjudication processes.
• Experience managing accounts receivable operations, aging inventory, and reimbursement workflows.
• Experience with EHR/PM systems and workflow tools such as Artiva, Epic, Cerner, Athena, or Meditech preferred.
• Excellent leadership, analytical, communication, and problem-solving skills.
• Ability to manage multiple priorities in a fast-paced operational environment.
• Experience working with offshore or cross-functional operational teams preferred.

Key Competencies

• Leadership & Coaching
• Revenue Cycle Knowledge
• Workers’ Compensation Regulatory Knowledge
• Analytical Thinking & Problem-Solving
• Denial Resolution & Recovery
• Communication & Collaboration
• Productivity & Quality Management
• Workflow Optimization
• Compliance & Confidentiality
• Accountability & Results Orientation
• Prioritization & Time Management

Work Conditions

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. You are acknowledging that you can perform the essential functions with or without a reasonable accommodation. The noise level in the work environment is usually moderately quiet. The work environment is primarily indoors. The position requires no travel.

This job description is not an exclusive or exhaustive list of all job functions that a team member in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced, or delegated by management to meet the business needs of the company.

We provide Equal Employment Opportunity for all individuals regardless of race, color, religion, gender, age, national origin, marital status, sexual orientation, status as a protected veteran, genetic information, status as a qualified individual with a disability and any other basis protected by federal, state or local laws.