Albert & Mackenzie is a well-established and expanding workers’ compensation defense law firm with a strong presence across California. Proudly recognized as a Great Place to Work for six consecutive years (2021–2026), the firm has also earned multiple Best Places to Work awards.
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.
Albert & Mackenzie ensures equal opportunity for all applicants regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other legally protected characteristics.
Full-time employees receive a competitive compensation package that features discretionary bonus opportunities and a comprehensive benefits program, including medical, vision, short-term and long-term disability, life insurance, a 401(k) retirement plan, paid time off, and optional dental coverage.
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