Workers Comp Authorization Coordinator

  • Precision Orthotics & Prosthetics, LLC
  • REMOTE UNITED STATES
  • 4mo ago
  • Full-Time
  • Remote

ForMotion is a global network of Orthotic and Prosthetic Patient Care clinics, focused on providing world-class, compassionate care for patients with mobility challenges. 
Our clinic is part of the ForMotion global network of Patient Care clinics owned by Embla Medical, which also owns Össur, a leading global provider of prosthetics and bracing and supports solutions; Fior & Gentz, an innovative developer of neuro orthotics; and College Park, creators of custom-built prosthetic solutions for people of all activity levels. 
We are dedicated to providing the best possible care to our patients to help them live Life Without Limitations.  


About the Role 
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.

What You’ll Do   
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.

Who You Are  

  • 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.

  • 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.

Why You’ll Feel Good Working Here 
We believe people do their best work when they feel good—personally and professionally. That’s why we offer:  

  • 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 

ForMotion is a global network of Orthotic & Prosthetic patient care clinics providing exceptional care through award-winning mobility solutions and world-class healthcare professionals.

Embla Medical is an equal opportunity employer and makes employment decisions on the basis of merit. We want to have the best available individual in every job.

Embla Medical's equal opportunity policy prohibits all discrimination (based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical disability, mental disability, military service, pregnancy, child birth or related medical condition, actual or perceived sexual orientation, or any other consideration made unlawful by local laws around the world).

Embla Medical is committed to complying with all applicable laws providing equal employment opportunities. This commitment applies to all individuals involved in the operations of Embla Medical and prohibits discrimination by any emplo​yee of Embla Medical, including supervisors and co-workers.

Important Warning: Beware of fraudulent recruiters impersonating our company. Please take extra caution when asked for any sensitive personal information, such as social security numbers or bank account details. We will never ask you for any form of payment during the recruitment process. Please make sure you refer to our official website.