Workers' Compensation Coordinator - AVALA Spine

Summary

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 attorneys—supporting 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

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…