Workers Compensation Specialist
ForMotionForMotion 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 Specialist (WCS) serves as a critical operational bridge and the primary owner of the authorization and reimbursement strategy for all workers’ compensation claims across their assigned ForMotion Clinics. In this capacity, the WCS operates as a high-level subject matter expert and strategic advisor, overseeing the pre-delivery management of claims to ensure excellence through administrative precision. This role is responsible for establishing the strategic direction for case management, exercising independent judgment to navigate complex reimbursement landscapes, and making key decisions regarding high-value negotiations and jurisdictional compliance to support the organization’s financial health and the timely delivery of patient care. Beyond strategic oversight, the WCS manages the intake-to-delivery workflow, securing favorable reimbursement rates and maintaining rigorous compliance standards to minimize financial risk. The role serves as the primary liaison between clinics, payers, and internal departments, ensuring seamless communication and operational alignment. The ideal candidate will possess strong knowledge of workers’ compensation processes and exhibit excellent interpersonal skills to support effective 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.
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.
Authorization & Utilization Review
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.
Rate Negotiation & Financial Approval
Determines 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.
Independently prices fee schedule exceptions and NOC (Not Otherwise Classified) codes, ensuring that complex O&P devices are reimbursed at rates that sustain organizational profitability.
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
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.
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
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.
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 employee 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.