Worker’s Comp and Liability Manager

About the role

This role collaborates closely with Billing, Sales Support, Compliance, and other cross-functional partners to support timely and accurate processing, strengthen documentation readiness, resolve operational barriers, and improve revenue cycle outcomes.

Responsibilities

• Provides direct leadership, coaching, and accountability to assigned team members while reinforcing company policies, customer service expectations, payer requirements, privacy standards, and established procedures.
• Focuses on consistent execution, team development, reporting, issue resolution, and continuous process improvement within the assigned area of responsibility.
• Manages the overall Worker’s Comp and Liability function, including workflow performance, quality outcomes, staffing needs, escalation support, reporting, and operational priorities.
• Establishes, maintains, and reinforces consistent documentation review standards, quality expectations, escalation pathways, productivity goals, and departmental procedures.
• Maintains departmental performance metrics, including accuracy, timeliness, productivity, backlog, aging, escalation volume, quality trends, and documentation outcomes; communicates results and recommended actions to leadership.
• Leads quality management routines, including audits, calibration discussions, trend reviews, corrective action plans, refresher training, and process updates to improve consistency and reduce preventable errors.
• Oversees escalated documentation issues, payer interpretation questions, operational barriers, and complex cases requiring management review or cross-functional resolution.
• Pairs with internal teams to improve documentation handoffs, authorization support, claims readiness, payer response workflows, system usage, case tracking, and communication standards across the order and claims process.
• Identifies process gaps, recurring documentation deficiencies, training needs, payer changes, system limitations, and operational risks; develops and implements action plans to address root causes.
• Collaborates with the Revenue Integrity function to ensure all processes within the function lead to successful cash collection in line with the appropriate RCM standards and timelines. This includes progressive actions taken to reduce the quantity of denials and support a proportionate clean cash metric.
• Supports workforce planning, onboarding, training programs, performance management, role clarity, workload balancing, and succession planning for the documentation review team.
• Ensures patient, provider, claims, and business information is handled in accordance with company policies, privacy standards, compliance expectations, and applicable documentation controls.
• Maintains and improves reporting, trackers, dashboards, SOPs, training materials, audit tools, and other operational resources that support documentation review accuracy and accountability.
• Participates in department planning, leadership updates, payer readiness efforts, audit preparation, process improvement initiatives, and other management responsibilities as assigned.

Qualifications

• High school diploma or equivalent required; associate degree or relevant healthcare coursework preferred.
• Minimum of five years of experience reviewing and interpreting medical records, claims documentation, clinical documentation, insurance documentation, prior authorization records, or related healthcare documentation.
• Minimum of three years of experience in a supervisory capacity specializing in the Worker’s Comp and Liability space.
• Working knowledge of medical terminology and the ability to understand documentation related to patient history, diagnoses, treatment plans, orders, and supporting clinical notes.
• Proficiency engaging with Attorneys and Third Party Administrators demonstrating excellent negotiation skills.
• Strong ability to coach team members, explain documentation expectations, and provide clear feedback in a professional and constructive manner.
• Strong attention to detail and ability to identify documentation gaps, inconsistencies, discrepancies, quality trends, and process improvement opportunities.
• Excellent written and verbal communication skills, including the ability to summarize findings, communicate expectations, and escalate issues clearly and professionally.
• Ability to interpret and reinforce established criteria, checklists, standard procedures, payer requirements, and leadership direction.
• Proficiency with Microsoft Office applications and the ability to use claims, documentation, authorization, reporting, or case management systems.
• Ability to manage competing priorities, team workload, escalations, and performance expectations in a fast-paced environment.

Preferred Experience

• Supervising or leading a documentation review, prior authorization, utilization review support, durable medical equipment, home health, specialty pharmacy, claims, or healthcare operations team.
• Experience conducting quality reviews, performance coaching, team training, workflow audits, or calibration sessions.
• Experience using electronic medical record systems, payer portals, claims platforms, document management tools, productivity trackers, or reporting dashboards.
• Familiarity with payer guidelines, coverage policies, audit documentation, medical review workflows, and healthcare compliance requirements.