Administrative Clerk
$37,440,000–$41,600,000 year
On-siteNew Hyde Park, New York, United States
Job Summary
Prepare and submit prior authorization requests for non-surgical treatments to Workers' Compensation carriers, tracking submissions through the review cycle and resubmitting as needed. Compile supporting clinical documentation to file Level 2 and Level 3 appeals for denied or modified authorizations, monitoring deadlines strictly per WCB timeframes. Distribute approved authorizations to physical therapy locations and patients while contacting outside medical practices to obtain necessary records. Maintain accurate records of all authorization requests, appeals, and correspondence within the practice management/EHR system, flagging recurring denial trends to management. Ensure all submissions comply with current NYS Workers' Compensation Board rules and documentation requirements.
Required Qualifications
- High school diploma or equivalent
- Associate's degree or higher
- Minimum of 2 years experience in workers' compensation administration or related field within healthcare or social assistance industries
- Strong knowledge of workers' compensation laws, regulations, and claims processing procedures
- Proficiency in using claims management software and Microsoft Office Suite
- Excellent communication and organizational skills with the ability to manage multiple cases simultaneously
- Ability to work independently and meet deadlines in a fast-paced environment
- Proficiency with EHR/practice management systems and Microsoft Office (Excel, Outlook)
- Must be authorized to work in the United States (E-Verify participation)
Desired Qualifications
- Associate's degree preferred
- 1+ years of experience in a medical office, billing, or insurance authorization role
- Experience with Workers' Compensation authorization/appeal processes
- No-Fault experience
- Strong written and verbal communication skills
- Highly organized with excellent follow-up skills and the ability to manage a high volume of concurrent requests
- Ability to address challenges proactively, facilitating timely resolutions and supporting employee recovery and return-to-work efforts
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