Workman's Comp Authorization

$500 sign-on bonus (payable after 90-days of employment)

The Workers’ Compensation (WC) Surgical Prior Authorization Specialist is responsible for managing all aspects of surgical authorization requests for assigned surgeons. This role ensures timely approval of procedures, accurate documentation, and effective communication with insurance carriers and healthcare teams. Extensive chart review will be required.

Key Responsibilities:

• Initiate and manage surgical authorization requests with insurance carriers for specified procedures
• Conduct outreach to insurers and adjusters to verify compensability and obtain utilization review (UR) contact details
• Submit required medical records to support authorization requests
• Track authorization status and updates using Excel spreadsheets
• Coordinate and complete appeals, including arranging peer-to-peer reviews when necessary
• Communicate authorization outcomes to surgeons, support staff, billing teams, and schedulers
• Notify appropriate teams of non-compensable claims and obtain written documentation of status changes
• Scan and upload all authorization-related documentation into patient charts
• Coordinate with schedulers once services are approved to ensure timely patient scheduling
• Maintain ongoing communication with workers’ compensation carriers, providers, nurses, and administrative staff
• Request authorization extensions and revise dates of service (DOS) as needed

Required Knowledge:

• Workers’ Compensation systems, processes, and benefits
• Applicable laws, regulations, and compliance standards
• Medical terminology
• CPT coding and ICD-10 diagnosis coding (medical and surgical)

Qualifications:

• 1+ year of experience obtaining Workers’ Compensation authorizations
• 1+ year of medical secretary or surgical coordinator experience
• Strong organizational skills and attention to detail
• Excellent customer service and communication skills
• Proficiency in Microsoft Outlook, Word, and Excel
• Experience with insurance verification processes
• Experience with EPIC (required)

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Experience:

• EPIC: 1 year (Required)
• Worker's Compensation Authorizations: 1 year (Preferred)
• Medical Secretary or Surgical Coordinator: 1 year (Required)

Shift availability:

• Day Shift (Required)

Ability to Commute:

• Stoneham, MA 02180 (Required)

Work Location: In person