RCM, Workers’ Compensation Manager

About the role

The Workers’ Compensation Manager, RCM oversees Workers’ Compensation revenue cycle operations to ensure timely, accurate, and compliant management of medical claims related to workplace injuries. This role provides leadership and operational oversight for Workers’ Compensation accounts receivable activities, denial management, claim resolution, workflow optimization, and team performance.

Responsibilities

• Provide leadership and oversight to Workers’ Compensation revenue cycle staff, including claim follow-up representatives, denial specialists, and support personnel.
• Establish performance expectations and monitor productivity, quality, and compliance metrics.
• Coach, mentor, and develop team members to ensure operational excellence and professional growth.
• Partner with leadership and offshore support teams to align workflows, staffing models, and operational priorities.
• Support onboarding, training, and ongoing education related to Workers’ Compensation regulations, payer requirements, and revenue cycle processes.
• Oversee daily Workers’ Compensation accounts receivable operations across multiple clients and payer groups.
• Ensure timely follow-up, documentation, escalation, and resolution of outstanding Workers’ Compensation claims.
• Review and manage inventory prioritization, aging accounts, and workflow assignments.
• Verify claim accuracy including: Employer information, Injury details, Claim numbers, Authorization requirements, State-specific Workers’ Compensation documentation.
• Ensure claims are billed and processed in accordance with payer requirements, client expectations, and state regulations.
• Oversee resolution of Workers' Compensation-specific claims issues including: Liability disputes, Authorization denials, Missing employer or carrier information, Underpayments and payment delays, Documentation deficiencies.
• Serve as an escalation point for complex or high-value Workers’ Compensation accounts.
• Collaborate with billing, coding, appeals, payment posting, and documentation teams to resolve claim barriers and improve reimbursement outcomes.
• Monitor denial trends and implement corrective action plans to improve claim recovery and reduce rework.
• Maintain effective communication with adjusters, employers, nurse case managers, and Workers’ Compensation carriers to support claim resolution.
• Maintain strict confidentiality and adhere to all HIPAA regulations governing PHI and PII.
• Complete all mandatory compliance and training courses set forth by TSI, including annual refresher courses and any client-specific training required for job performance.

Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Finance, or related field preferred.
• 5+ years of experience in Revenue Cycle Management, Workers’ Compensation claims, or healthcare reimbursement operations.
• 2+ years of leadership or supervisory experience preferred.
• Strong knowledge of Workers’ Compensation regulations, payer requirements, denial management, and claim adjudication processes.
• Experience managing accounts receivable operations, aging inventory, and reimbursement workflows.
• Experience with EHR/PM systems and workflow tools such as Artiva, Epic, Cerner, Athena, or Meditech preferred.
• Excellent leadership, analytical, communication, and problem-solving skills.
• Ability to manage multiple priorities in a fast-paced operational environment.
• Experience working with offshore or cross-functional operational teams preferred.