Workers Comp Authorization Coordinator

Össur

About The Position

The Workers’ Compensation Authorization Coordinator (WCAC) serves as a critical operational bridge within ForMotion Clinics, overseeing the pre-delivery management of all workers’ compensation claims across assigned prosthetic and orthotic locations. This role is designed to ensure excellence through administrative precision—managing the intake-to-delivery workflow, securing favorable reimbursement rates and approvals, and maintaining rigorous compliance standards. The WCAC minimizes financial risk by ensuring all services are appropriately authorized and negotiated before patient delivery, while also serving as a critical liaison between the clinics, payers, and internal departments. The ideal candidate will have strong knowledge of workers’ compensation processes and excellent interpersonal skills to support negotiation and collaboration with payer contacts.

Requirements

High school diploma required, associate or bachelor’s degree in healthcare administration, business, or related field preferred.
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.
Proficient with Microsoft Office, Opie/Nymbl EMRs, ICD10 coding, medical terminology.

Nice To Haves

Prior experience as a Patient Care Specialist or other administrator within the company’s shared services departments desired but not required.

Responsibilities

Intake & Referral Management Expedite the intake of incoming referrals, ensuring immediate coordination of initial evaluations to maintain clinical momentum and prevent care delays.
Verify and maintain 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.
Authorization & Utilization Review Prepare, submit, and aggressively follow-up on Prior Authorization (PA) requests.
Ensure all approvals are secured and documented before casting, fabrication, or fitting begins.
Identify and manage complex cases flagged for high-level utilization review (UR) with precision.
Track authorization lifecycles and expiration dates, submitting renewal requests preemptively to ensure an uninterrupted patient care plan.
Rate Negotiation & Financial Approval 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.
Price and negotiate fee schedule exceptions, NOC codes, and non-contracted services to guarantee adequate margin and coverage for complex O&P devices.
Maintain meticulous records of authorized HCPCS codes and approved rates to ensure seamless hand-offs to the billing department and 100% reimbursement accuracy.
Clinical Documentation & Compliance Collaborate with Prosthetists and Orthotists to refine clinical rationales, ensuring documentation and coding meets the specific requirements of workers' comp payers.
Monitor and maintain strict compliance with state workers’ compensation laws and specific jurisdictional mandates throughout the pre-delivery phase.
Collaboration & Support 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.
Reporting 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.

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