Workers' Compensation Coordinator - AVALA Spine - Full-Time

Workers' Compensation Coordinator

As part of the Workers' Compensation coordination team, this role contributes to the collective management of scheduling, authorization requests, and care coordination for injured workers. The team works together to ensure clear and consistent communication among patients, healthcare providers, workers' compensation carriers, case managers, and attorneyssupporting timely claims processing and the appropriate delivery of medical services. Team members share responsibilities for handling medical records, documentation, and administrative tasks to promote efficient clinic workflows and maintain compliance with regulatory standards.

Essential Duties and Responsibilities

Patient Intake & Information Collection

• Collect and accurately input patient demographics, payer/claim information, and billing details to ensure appointments and services are processed correctly.
• Obtain medical records and documentation related to the injury and prior treatment to support continuity of care.
• Provide patients, adjusters, and nurse case managers with pre-registration instructions and clinic directions.

Appointment Scheduling

• Coordinate and schedule workers' compensation appointments within provider schedules, ensuring patient flow is efficient and aligned with individual care needs.
• Maintain oversight of WC appointment to match the patient's status and treatment requirements.

Documentation & Medical Records Preparation

• Ensure all necessary medical documentation is collected and uploaded to the patient's chart prior to appointments.
• Prepare and organize the patient file to support provider evaluation and treatment planning.

Authorization Management

• Submit prior authorization requests for provider-ordered services, including ancillary services (e.g., MRI, CT, Physical Therapy, PRP injections, joint medications, referrals), surgical procedures, and office visits.
• Include supporting medical documentation and work status reports with all submissions.
• Collaborate with adjusters and nurse case managers to obtain timely approvals.
• Submit appeals when necessary and document all authorization activity in the EHR.

Care Coordination & Follow-Up

• Coordinate approved services with external providers (imaging centers, PT clinics, other specialists).
• Communicate follow-up instructions to patients and ensure necessary records (e.g., imaging reports, PT progress notes, consult notes) are received and documented.
• Act as a liaison between patients, providers, adjusters, nurse case managers, and attorneys to ensure cohesive communication and follow-through.

Ongoing Case & Workflow Management

• Maintain clear and ongoing communication with all parties involved, keeping them informed of case status.
• Accurately document all communications, authorizations, and case-related updates in the EHR.
• Manage calendars and tasks to ensure timelines and treatment plans are followed.
• Ensure strict confidentiality and proper handling of sensitive case information and records.

Cross-Functional Support & Administration

• Understand multiple clinic workflows and how each department interacts with the workers' comp process.
• Assist with communications, administrative tasks, and cross-departmental coordination as needed.
• Perform other related duties as assigned and assist in other departments as deemed necessary by management.

Professionalism & Development

• Maintain high levels of integrity and discretion when dealing with professionals inside and outside the company.
• Participate in training and educational opportunities to stay current with job knowledge and industry best practices.

Core Competencies

Action Orientation - Targets and achieves results, overcomes obstacles, accepts responsibility, establishes standards and responsibilities, creates a results-oriented environment, and follows through on actions.

Communications - Communicates well both verbally and in writing. Effectively conveys and shares information and ideas with others. Listens carefully and understands various viewpoints. Presents ideas clearly and concisely and understands relevant detail in presented information.

Creativity/Innovation - Generates novel ideas and develops or improves existing and new systems that challenge the status quo, takes risks, and encourages innovation.

Critical Judgment - Possesses the ability to define issues and focus on achieving workable solutions. Consistently does the right thing by performing with reliability.

Customer Orientation - Listens to customers, builds customer confidence, increases customer satisfaction, ensures commitments are met, sets appropriate customer expectations, and responds to customer needs.

Interpersonal Skills - Effectively and productively engages with others and establishes trust, credibility, and confidence with others.

Leadership - Motivates, empowers, inspires, collaborates with, and encourages others. Builds consensus when appropriate. Focuses team members on common goals.

Teamwork - Knows when and how to attract, develop, reward, and utilize teams to optimize results. Acts to build trust, inspire enthusiasm, encourage others, and help resolve conflicts and develop consensus in creating high-performance teams.

Professional Requirements

• Prior healthcare experience required; experience with medical authorizations and/or care coordination preferred.
• Workers' compensation experience preferred.
• Proven administrative or assistant experience in a medical or clinical setting.
• Ability to read and interpret electronic medical records and treatment plans.
• Educated on and compliant with HIPAA regulations; maintains strict patient confidentiality.
• Demonstrates professionalism in all duties, interactions, and communications.
• Strong customer service orientation with the ability to communicate effectively across roles and settings.
• Dependable, adaptable, and able to work collaboratively in a team environment.

Regulatory Requirements

• High school diploma, GED, or equivalent required.
• Additional degrees, certifications, or training may be considered toward qualifications.
• Must have computer skills and dexterity required for data entry and retrieval of patient information.
• Proficiency with Windows-based applications and medical software systems.
• Previous experience with medical software and scheduling platforms preferred.
• Understanding and compliance with all HIPAA and patient privacy regulations.

Skills

• Excellent verbal and written communication skills.
• Strong organizational, calendaring, and administrative skills.
• High attention to detail with accurate recordkeeping and documentation.
• Excellent time management with the ability to multitask and meet deadlines.
• Proficient in Microsoft Excel and other office software tools.
• Strong problem-solving and critical thinking abilities.
• Effective at prioritizing tasks in a fast-paced, deadline-driven environment.
• Solid writing, proofreading, and information preparation skills.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This position is very active and requires repetitive motions, standing, walking, bending, kneeling and stooping all day. The employee must frequently lift or move items weighing up to 50 pounds.