Administrative Clerk

Job Description

Job Description

About the Role:

The WC Coordinator plays a critical role in managing and facilitating workers' compensation processes within healthcare and social assistance settings. This position ensures timely and accurate handling of workers' compensation claims, coordinating between injured employees, healthcare providers, insurance carriers, and internal departments. The coordinator is responsible for maintaining compliance with relevant laws and regulations while supporting employees through their recovery and return-to-work plans. By effectively managing case documentation and communication, the WC Coordinator helps minimize organizational risk and supports operational continuity. Ultimately, this role contributes to a safe and supportive work environment by overseeing the entire workers' compensation lifecycle with professionalism and attention to detail.

Minimum Qualifications:

• High school diploma or equivalent; Associate’s degree or higher preferred.
• Minimum of 2 years experience in workers' compensation administration or related field within healthcare or social assistance industries.
• Strong knowledge of workers' compensation laws, regulations, and claims processing procedures.
• Proficiency in using claims management software and Microsoft Office Suite.
• Excellent communication and organizational skills with the ability to manage multiple cases simultaneously.

Preferred Qualifications:

• High school diploma or equivalent (Associate's degree preferred)
• 1+ years of experience in a medical office, billing, or insurance authorization role
• Experience with Workers' Compensation authorization/appeal processes strongly preferred (No-Fault experience a plus)
• Strong written and verbal communication skills
• Highly organized with excellent follow-up skills and the ability to manage a high volume of concurrent requests
• Proficiency with EHR/practice management systems and Microsoft Office (Excel, Outlook)
• Ability to work independently and meet deadlines in a fast-paced environment

Responsibilities:

• Prior Authorization Management
  • Prepare and submit requests for authorization for non-surgical treatments (PT, injections, DME, diagnostics, EMG, etc.) to Workers' Compensation carriers
  • Track submitted requests through the review cycle and follow up proactively on pending or delayed determinations
  • Update and resubmit requests as needed based on payor requests for additional information

• Appeals

  • Prepare and submit Level 2 and Level 3 appeals for denied or modified authorizations, including compiling supporting clinical documentation and medical necessity justification
  • Monitor appeal deadlines and ensure timely filing in accordance with WCB timeframes
  • Maintain organized records of appeal status and outcomes

• Communication & Coordination

  • Distribute approved authorizations to physical therapy locations and to patients in a timely manner
  • Contact outside medical practices to request and obtain medical records needed to support authorization and appeal submissions
  • Confirm attorney representation on patient claims and maintain up-to-date attorney contact information
  • Prepare and send Liens to attorneys for signature, and track their return

• Documentation & Compliance

  • Maintain accurate, organized records of all authorization requests, appeals, correspondence, and supporting documentation within the practice management/EHR system
  • Ensure all submissions comply with current NYS Workers' Compensation Board rules, timeframes, and documentation requirements
  • Flag recurring denial trends or payor issues to management

Skills:

The WC Coordinator utilizes strong organizational skills daily to track and manage multiple workers' compensation cases efficiently, ensuring deadlines and compliance requirements are met. Effective communication skills are essential for coordinating between injured employees, medical providers, insurance carriers, and internal teams, fostering clear and empathetic interactions. Analytical skills are applied to review case details, interpret regulations, and prepare accurate reports that inform management decisions. Proficiency with claims management software and Microsoft Office tools supports the accurate documentation and reporting of case progress. Additionally, problem-solving skills enable the coordinator to address challenges proactively, facilitating timely resolutions and supporting employee recovery and return-to-work efforts.

We are proud to be an equal opportunity workplace and an affirmative action employer. As such, individuals are recruited, hired, assigned, and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic. Please note we participate in E-Verify and will provide the federal government with your I-9 Form information to confirm that you are authorized to work in the United States.ator to address challenges proactively, facilitating timely resolutions and supporting employee recovery and return-to-work efforts.