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As a Lien Representative, you will be responsible for the timely and accurate resolution of Workers' Compensation lien claims on behalf of our clients. This includes reviewing medical and non-medical billing, assessing exposure, preparing files for negotiation or litigation, and ensuring compliance with applicable California Workers' Compensation regulations and billing guidelines. Your work plays a vital role in reducing liability and supporting effective case resolution strategies.

Key Responsibilities Include but Are Not Limited To:

1. File Review & Resolution Preparation

• Review and analyze lien claims to assess validity, billing practices, and exposure.
• Compare billed services to accepted body parts and treatment authorization; flag issues related to duplication, over-utilization, and unsupported charges.
• Audit bills in line with the Official Medical Fee Schedule (OMFS), MTUS guidelines, and the DIR Drug Formulary.
• Identify inappropriate billing (e.g., unbundled CPT codes, incorrect fee schedule application, overpricing, or off-formulary medications).
• Research and document billing disputes to support negotiation or litigation.
• Prepare case summaries, authority requests, and recommendations for resolution.
• Organize findings in a manner that allows litigation or hearing representatives to proceed confidently with hearings if needed.

2. Discovery & Exhibit Preparation

• Assist in the preparation and e-filing of Discovery and Trial Exhibits, including the use of internal templates to ensure compliance with WCAB requirements.
• Verify that documents are properly served and admissible.
• Support Hearing Representatives with pre-trial documentation.

3. Negotiations & WCAB Appearances

• Negotiate settlements with lien claimants (e.g., interpreters, chiropractors, imaging centers) via phone or email.
• Under guidance, participate in lower-complexity WCAB lien appearances or OTOCs.
• Apply legal, medical, and technical knowledge to drive down settlement values.

4. Billing

• Responsible for billing 8–10 hours per day, in accordance with established billing guidelines.
• Ensure that time is logged accurately and that all billed activity reflects productive, client-facing work.
• Any exceptions or non-billable tasks must be discussed with management in advance.
• Billing compliance is a key performance metric and will be regularly reviewed by leadership.

5. Case Management & Reporting

• Maintain accurate, detailed notes in the case management system.
• Update internal databases and trackers regularly.
• Submit timely, professional reports following established templates and protocols.
• Proficiency in systems such as A1, ProLaw, Merus, or PerfectLaw is highly preferred.

6. Special Projects

• Participate in special assignments such as bulk settlements, client audits, or file closure projects.
• Assist with intake or file audits as needed.

Work Environment:

• Regular business hours (M–F typically 8:30-5pm).
• Primarily remote; occasional travel to WCAB locations may be required.
• Must be able to lift up to 15 lbs for file transport during in-person events or special projects.

Qualifications:

• 1–3+ years of experience in lien defense within Workers' Compensation (defense firm experience strongly preferred).
• Solid understanding of California WCAB procedures, OMFS, MTUS, and EAMS.
• Strong organizational and time management skills.
• Excellent communication (written and verbal) and negotiation abilities.
• Familiarity with medical billing codes, provider profiling, and treatment authorization processes.
• Paralegal certificate or equivalent legal education/training is a plus.

Performance Expectations:

• Meet or exceed daily billing goals.
• Demonstrate accuracy and professionalism in all reporting and file handling.
• Communicate clearly and effectively with clients and opposing parties.
• Represent the firm professionally in all negotiations and WCAB interactions.
• Comply with company policies and procedures at all times.