Össur

Workers Compensation Specialist

Össur

full-time

Posted on:

Location Type: Remote

Location: United States

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About the role

  • Expedite the intake of incoming referrals, ensuring immediate coordination of initial evaluations to maintain clinical momentum and prevent care delays.
  • Oversee and verify accurate patient and payer profiles within the EMR, ensuring all state-specific jurisdictional guidelines, benefit limitations, and coverage scopes are identified at the point of entry.
  • Proactively request and review clinical documentation from referring providers to ensure all necessary records for authorization are present and compliant.
  • Oversee and handle the process of Preparing, submitting, and aggressively follow-up on Prior Authorization (PA) requests.
  • Ensure all approvals are secured and documented before casting, fabrication, or fitting begins.
  • Exercises independent discretion to categorize and prioritize the caseload, determining which high-risk or high-value claims require immediate escalation or specialized advocacy.
  • Track authorization lifecycles and expiration dates, submitting renewal requests preemptively to ensure an uninterrupted patient care plan.
  • Determining carrier network and ultimate responsible payer to ensure appropriate reimbursement.
  • Partner with carriers and Third-Party Administrators (TPAs) to secure Purchase Orders (POs), Single Case Agreements (SCAs), or Letters of Authorization (LOAs) prior to delivery.
  • Holds the authority to negotiate Purchase Orders (POs), Single Case Agreements (SCAs), and Letters of Authorization (LOAs), and decides when payer terms are financially acceptable or when to escalate for further negotiation based on margin requirements.
  • Maintain meticulous records of authorized HCPCS codes and approved rates to ensure seamless hand-offs to the billing department and 100% reimbursement accuracy
  • Functions as the subject matter expert for clinical teams regarding federal and state-specific workers’ compensation laws, providing the necessary regulatory insights to ensure that clinical care plans align with jurisdictional reimbursement requirements and coverage mandates.
  • Review clinical coding and documentation to ensure strict compliance with federal and state workers’ compensation laws and specific jurisdictional mandates throughout the pre-delivery phase.
  • Serve as the primary liaison between clinicians, adjusters, TPAs, and UR nurses to facilitate seamless authorization and communication standards.
  • Process and monitor workers’ compensation claims from initial referral through final delivery (hand-off to billing).
  • Work closely with other internal departments including clinic staff, contracting, and revenue cycle departments to ensure timely care, accurate reimbursement, and clean claim submission.
  • Provide regular feedback on authorization workflows, highlighting denial trends and negotiation bottlenecks to ensure timely payer approvals.
  • Perform additional duties assigned to support the evolving operational needs and financial success of ForMotion Clinics.

Requirements

  • Bachelor’s degree in business, healthcare, or related field or equivalent combination of education and experience required.
  • 2+ years of experience in the O&P industry utilizing EMR systems.
  • Prior experience and working knowledge of WC carriers, third-party administrators, and WC including authorizations, pricing/negotiations, and appeals/denials.
  • Strong comprehension of State and Federal WC regulations and interpretation of payer contract language.
  • Prior experience as a Patient Care Specialist or other administrator within the company’s shared services departments desired, but not required.
  • Proficient with Microsoft Office, Opie/Nymbl EMRs, ICD10 coding, medical terminology.
Benefits
  • A culture rooted in trust, empathy, and Nordic-inspired flat hierarchies
  • Tailored onboarding and a buddy system to help you feel at home from day one
  • Continuous learning through e-learning, training, and language courses
  • A “you” culture where everyone—from interns to executives—is treated with respect
  • Competitive Compensation Packages
  • Medical, Dental, and Vision Benefits
  • 401(k) Retirement Plan with employer matching contribution
  • 8 paid holidays
  • 13 vacation days, birthday and two (2) volunteer day
  • 8 sick days within your first year of employment
  • Paid Parental Bonding

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
EMR systemsICD10 codingclinical documentation reviewauthorization processingworkers' compensation claims managementnegotiationcompliance with regulationsmedical terminologydata trackingrecord keeping
Soft skills
communicationorganizationindependent discretionproblem-solvingcollaborationattention to detailadvocacyfeedback provisionprioritizationescalation management