Worker’s Compensation & MVA Coordinator

Sturdy Memorial Hospital•Attleboro, MA

8d•$21 - $32•Onsite

About The Position

The Worker's Compensation & Motor Vehicle Accident (WC/MVA) Coordinator is responsible for coordinating and managing workers' compensation and motor vehicle accident claims throughout a patient's course of treatment. This role serves as a liaison between patients, providers, insurance carriers, attorneys, nurse case managers, and internal departments to ensure appropriate authorization, coordination of care, and reimbursement for services. A key responsibility of this position is negotiating reimbursement rates and securing authorization approvals with Workers' Compensation carriers for initial provider consultations, surgical procedures, and other medically necessary services. The Coordinator works to obtain reimbursement rates above state-mandated fee schedules when appropriate, helping to maximize revenue while ensuring patients receive timely access to care. The Coordinator facilitates claim setup, authorization management, reimbursement negotiations, scheduling, and documentation processing while supporting efficient patient care, regulatory compliance, and financial stewardship for the organization.

Requirements

High School diploma or equivalent
Minimum of 1-2 years of medical billing, medical office, or healthcare administrative experience.
Experience working with Workers' Compensation and/or Motor Vehicle Accident claims.
Knowledge of Personal Injury Protection (PIP) exhaustion requirements and coordination of benefits.
Understanding of CPT, ICD-10, and HCPCS coding.
Ability to review and interpret medical documentation.
Strong organizational and time management skills.
Excellent verbal and written communication skills.
Ability to prioritize multiple tasks in a fast-paced environment.
Strong analytical, problem-solving, and customer service skills.
Proficiency with electronic medical records and healthcare software applications.

Nice To Haves

Previous experience negotiating reimbursement rates, surgical authorizations, and initial consultation fees with Workers' Compensation insurance carriers and adjusters.
Demonstrated knowledge of Workers' Compensation fee schedules, DIA reimbursement guidelines, and payer contract negotiations.
Ability to effectively advocate for appropriate reimbursement while maintaining positive working relationships with insurance carriers and case managers.
Experience in orthopedic or specialty medical practice.
Familiarity with medical terminology, anatomy, and physiology.
Experience obtaining prior authorizations and insurance verification.

Responsibilities

Establish and maintain Workers' Compensation (WC) and Motor Vehicle Accident (MVA) cases within the electronic medical record system.
Obtain and verify claim information with insurance carriers, adjusters, attorneys, and nurse case managers.
Negotiate reimbursement rates with Workers' Compensation carriers and adjusters for initial provider consultations, surgical procedures, and other authorized services to maximize reimbursement and ensure appropriate compensation for services rendered.
Secure and document written approval for negotiated reimbursement rates, treatment plans, surgeries, and other medically necessary services prior to scheduling.
Coordinate authorizations and approvals for office visits, evaluations, diagnostic testing, surgeries, physical therapy, occupational therapy, second opinions, and other medically necessary services.
Monitor negotiated agreements and authorization approvals to ensure reimbursement terms are accurately documented, communicated, and billed.
Serve as the primary liaison between providers, insurance carriers, adjusters, attorneys, nurse case managers, patients, and internal departments regarding authorizations, reimbursement negotiations, treatment approvals, and claim-related issues.
Communicate with insurance carriers and adjusters regarding coverage determinations, treatment authorizations, reimbursement approvals, and claim status updates.
Process and manage incoming and outgoing communications related to WC/MVA claims.
Assist with scheduling urgent and high-priority patients referred from Occupational Health Services, Emergency Departments, and outside facilities.
Review and respond to requests from attorneys, insurance representatives, and nurse case managers regarding treatment status, medical records, and care updates.
Manage appointment changes and coordination requests from nurse case managers and insurance carriers.
Collaborate with providers, leadership, and the Central Billing Office (CBO) to resolve authorization, reimbursement, and claim-related issues and optimize financial outcomes.
Work closely with Patient Financial Services, hospital departments, and outside organizations to ensure accurate claim processing and payment resolution.
Maintain accurate, complete, and timely documentation in accordance with organizational policies, payer requirements, and regulatory standards.
Perform other duties as assigned.