Administrative Clerk

American Orthopedic Partn•New York, NY

21h

About The Position

The WC Coordinator manages and facilitates workers’ compensation processes in healthcare and social assistance settings. The role handles workers’ compensation claims and coordinates among injured employees, healthcare providers, insurance carriers, and internal departments. It supports compliance with relevant laws and regulations, manages case documentation and communication, and supports employee recovery and return-to-work plans. The coordinator prepares and tracks prior authorization requests for non-surgical treatments, submits appeals for denied or modified authorizations, coordinates records and communications with medical practices and attorneys, and maintains accurate case records in the practice management or EHR system. The position also monitors deadlines and documentation requirements under current New York State Workers’ Compensation Board rules and flags recurring denial trends or payer issues to management.

Requirements

High school diploma or equivalent.
At least 2 years of experience in workers’ compensation administration or a related field within healthcare or social assistance industries.
Strong knowledge of workers’ compensation laws, regulations, and claims processing procedures.
Proficiency with claims management software and Microsoft Office Suite.
Excellent communication and organizational skills, including the ability to manage multiple cases simultaneously.

Nice To Haves

Associate’s degree or higher preferred.
Experience in a medical office, billing, or insurance authorization role.
Experience with Workers’ Compensation authorization and appeal processes; No-Fault experience is 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 or practice management systems and Microsoft Office, including Excel and Outlook.
Ability to work independently and meet deadlines in a fast-paced environment.

Responsibilities

Prepare and submit requests for authorization for non-surgical treatments, including physical therapy, injections, durable medical equipment, diagnostics, and EMG, to Workers’ Compensation carriers.
Track authorization requests through the review cycle and follow up on pending or delayed determinations.
Update and resubmit requests when payers request additional information.
Prepare and submit Level 2 and Level 3 appeals for denied or modified authorizations, compiling supporting clinical documentation and medical necessity justification.
Monitor appeal deadlines and file within Workers’ Compensation Board timeframes.
Maintain organized records of appeal status and outcomes.
Distribute approved authorizations to physical therapy locations and patients in a timely manner.
Contact outside medical practices to request and obtain medical records for authorization and appeal submissions.
Confirm attorney representation on patient claims and maintain current attorney contact information.
Prepare and send liens to attorneys for signature and track their return.
Maintain accurate, organized records of authorization requests, appeals, correspondence, and supporting documentation in the practice management or EHR system.
Ensure submissions comply with current New York State Workers’ Compensation Board rules, timeframes, and documentation requirements.
Flag recurring denial trends or payer issues to management.
Coordinate communication among injured employees, medical providers, insurance carriers, and internal teams.
Support employee recovery and return-to-work efforts.