This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

The Authorization Denial Appeal Specialist is responsible for managing and appealing denied prior authorizations for orthotic and prosthetic (O&P) devices across U.S ForMotion Clinics. This role partners closely with patients, clinicians, prescribing physicians, and payers to obtain required documentation, prepare comprehensive appeal submissions, and guide cases through payer review processes.

• Manage end to end appeal workflows for denied prior authorizations related to orthotic and prosthetic devices.
• Collaborate with patients, clinicians, and prescribing physicians to obtain medical records, clinical notes, letters of medical necessity, and other supporting documentation required for appeals.
• Obtain, track, and maintain signed Appointment of Representative (AOR) forms from patients to enable payer communication.
• Research payer manuals, coverage guidelines, medical policies, and provider portals to identify denial rationale and appeal requirements.
• Develop customized, case by case appeal strategies based on clinical justification, payer policy, and documentation standards.
• Draft clear, comprehensive, and payer specific appeal letters supporting medical necessity and policy alignment.
• Compile and submit complete appeal packages through payer portals, fax, mail, or other required submission channels.
• Monitor appeal status through payer systems and follow up as needed to ensure timely review and resolution.
• Coordinate and participate in Peer to Peer (P2P) reviews when required, including preparation of supporting materials and scheduling with clinicians or prescribing physicians.
• Proactively communicate appeal status, updates, approvals, and denials to both the patient and the clinic throughout the review process.
• Track appeal deadlines, determinations, and outcomes to ensure compliance with payer timelines.
• Maintain accurate, compliant documentation in EMR systems and internal tracking tools.
• Provide non-managerial guidance and subject matter support to peers regarding authorization and appeal processes.
• Ensure strict adherence to HIPAA and other legal and ethical standards in the handling of protected health information.

Qualifications

• 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 Commercial, Medicare, & Medicaid Insurances including authorizations, appeals/denials.
• Proficient with Microsoft Office, Opie/Nymbl EMRs, ICD10 coding, medical terminology.

Requirements

• Ethical Conduct
• Computer Proficiency
• Demonstrates excellent people skills with the ability to interface with patients, physicians, and coworkers in a tactful, informed and service-oriented manner.
• Detailed oriented.
• Experience coordinating and participating in Peer to Peer (P2P) reviews.
• Familiarity with Medicare, Medicaid, and commercial payer policies as they relate to O&P services.
• Ability to interpret complex payer policy language and apply it to clinical scenarios.
• Strong analytical, problem solving, and critical thinking skills.
• Professional, patient centered communication style.
• Ability to balance patient advocacy with payer compliance and regulatory requirements.

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.
• 9 paid holidays.
• 13 vacation days, birthday and two (2) volunteer days.
• 8 sick days within your first year of employment.
• Paid Parental Bonding.
• The US hourly range for this full-time position is $29.38 - $31.25/hr + bonus + benefits.