Workers’ Compensation Specialist

Altivera Medical; Denver (CO); On-site; USD 65,000 - 90,000; Full time

Job summary

Altivera Medical seeks a seasoned Workers' Compensation Coordinator to manage a caseload from intake to closure, coordinating authorizations, benefit verifications, and follow-up with providers, patients, and payers to ensure accurate documentation and timely communication.

Ideal candidates have WC claims experience, HIPAA compliance, and reimbursement workflows, with strong organizational and interpersonal skills to navigate complex cases and collaborate across teams.

Qualifications

• Experience with Workers' Compensation claims and regulatory requirements.
• Strong understanding of insurance reimbursement and DME operations.
• Excellent written and verbal communication and stakeholder management.

Responsibilities

• Build and maintain relationships with providers, clinics, injured patients, insurance adjusters, nurse case managers, TPAs, and internal teams.
• Coordinate DME and Workers' Compensation authorizations, including verification of benefits and eligibility, prior authorization, and payer follow-up.
• Manage assigned WC cases from referral through resolution, including intake, authorization, fulfillment, follow-up, reimbursement support, and closure.
• Educate patients regarding equipment, documentation, insurance, financial responsibility, and communication expectations.
• Maintain knowledge of WC statutes, fee schedules, billing requirements, documentation standards, CMS, HIPAA, and Medicare Secondary Payer requirements.
• Escalate issues and collaborate with Territory Managers, Sales, Order Entry, and other teams to remove barriers.
• Maintain accurate case documentation and provide timely updates to stakeholders throughout the lifecycle.

Skills

Workers' Comp claims

Nurse case management

HIPAA compliance

Prior authorization

Revenue cycle

Communication skills

Relationship management

Organization & time management

Problem solving

Medical terminology

Education

Bachelor's degree in Healthcare Administration

Job description

Job Details

• Workers' Compensation Case Management - Coordinates assigned cases across intake, authorization, fulfillment, reimbursement support, and closure.
• Authorization & Payer Coordination - Navigates eligibility, benefits, prior authorization, payer follow-up, and Workers' Compensation requirements.
• Stakeholder Relationship Management - Builds productive relationships with providers, patients, adjusters, nurse case managers, TPAs, and internal partners.
• Documentation & Regulatory Knowledge - Applies knowledge of Workers' Compensation documentation, fee schedules, billing standards, and applicable privacy requirements.
• Issue Resolution & Communication - Resolves case barriers and communicates clearly regarding coverage, documentation, service expectations, and next steps.
• Organization & Accountability - Manages multiple complex cases while maintaining accuracy, timely follow-through, and productivity standards.
• Build and maintain professional relationships with providers, clinics, injured patients, insurance adjusters, nurse case managers, TPAs, and internal teams.
• Coordinate DME and Workers' Compensation authorizations, including verification of benefits and eligibility, prior authorization, and payer follow-up.
• Manage assigned Workers' Compensation cases from referral through resolution, including intake, authorization, fulfillment, follow-up, reimbursement support, and closure.
• Conduct Workers' Compensation enrollment calls and educate patients regarding equipment, documentation, insurance, financial responsibility, and communication expectations.
• Maintain working knowledge of Workers' Compensation statutes, state fee schedules, billing requirements, documentation standards, CMS, HIPAA, and Medicare Secondary Payer requirements, as applicable.
• Identify and resolve issues involving authorizations, documentation, coverage, billing, payments, payer interpretation, and service expectations.
• Coordinate with Territory Managers, Sales, Order Entry, Order Completion, and other operational teams to address case needs and remove barriers.
• Maintain accurate case documentation and provide timely, proactive updates to relevant stakeholders throughout the case lifecycle.
• Maintain confidentiality of patient, provider, and claims information in accordance with company policies and applicable privacy standards.
• Follow established escalation pathways when additional review, clarification, or supervisory guidance is required.
• Meet defined productivity, accuracy, and quality expectations while managing competing priorities and maintaining attention to detail.
• Perform other case coordination, documentation review, and administrative support duties as assigned.

Core Competencies

• Workers' Compensation Case Management - Coordinates assigned cases across intake, authorization, fulfillment, reimbursement support, and closure.
• Authorization & Payer Coordination - Navigates eligibility, benefits, prior authorization, payer follow-up, and Workers' Compensation requirements.
• Stakeholder Relationship Management - Builds productive relationships with providers, patients, adjusters, nurse case managers, TPAs, and internal partners.
• Documentation & Regulatory Knowledge - Applies knowledge of Workers' Compensation documentation, fee schedules, billing standards, and applicable privacy requirements.
• Issue Resolution & Communication - Resolves case barriers and communicates clearly regarding coverage, documentation, service expectations, and next steps.
• Organization & Accountability - Manages multiple complex cases while maintaining accuracy, timely follow-through, and productivity standards.
• Build and maintain professional relationships with providers, clinics, injured patients, insurance adjusters, nurse case managers, TPAs, and internal teams.
• Coordinate DME and Workers' Compensation authorizations, including verification of benefits and eligibility, prior authorization, and payer follow-up.
• Manage assigned Workers' Compensation cases from referral through resolution, including intake, authorization, fulfillment, follow-up, reimbursement support, and closure.
• Conduct Workers' Compensation enrollment calls and educate patients regarding equipment, documentation, insurance, financial responsibility, and communication expectations.
• Maintain working knowledge of Workers' Compensation statutes, state fee schedules, billing requirements, documentation standards, CMS, HIPAA, and Medicare Secondary Payer requirements, as applicable.
• Identify and resolve issues involving authorizations, documentation, coverage, billing, payments, payer interpretation, and service expectations.
• Coordinate with Territory Managers, Sales, Order Entry, Order Completion, and other operational teams to address case needs and remove barriers.
• Maintain accurate case documentation and provide timely, proactive updates to relevant stakeholders throughout the case lifecycle.
• Maintain confidentiality of patient, provider, and claims information in accordance with company policies and applicable privacy standards.
• Follow established escalation pathways when additional review, clarification, or supervisory guidance is required.
• Meet defined productivity, accuracy, and quality expectations while managing competing priorities and maintaining attention to detail.
• Perform other case coordination, documentation review, and administrative support duties as assigned.

Essential Duties & Responsibilities

• Build and maintain professional relationships with providers, clinics, injured patients, insurance adjusters, nurse case managers, TPAs, and internal teams.
• Coordinate DME and Workers' Compensation authorizations, including verification of benefits and eligibility, prior authorization, and payer follow-up.
• Manage assigned Workers' Compensation cases from referral through resolution, including intake, authorization, fulfillment, follow-up, reimbursement support, and closure.
• Conduct Workers' Compensation enrollment calls and educate patients regarding equipment, documentation, insurance, financial responsibility, and communication expectations.
• Maintain working knowledge of Workers' Compensation statutes, state fee schedules, billing requirements, documentation standards, CMS, HIPAA, and Medicare Secondary Payer requirements, as applicable.
• Identify and resolve issues involving authorizations, documentation, coverage, billing, payments, payer interpretation, and service expectations.
• Coordinate with Territory Managers, Sales, Order Entry, Order Completion, and other operational teams to address case needs and remove barriers.
• Maintain accurate case documentation and provide timely, proactive updates to relevant stakeholders throughout the case lifecycle.
• Maintain confidentiality of patient, provider, and claims information in accordance with company policies and applicable privacy standards.
• Follow established escalation pathways when additional review, clarification, or supervisory guidance is required.
• Meet defined productivity, accuracy, and quality expectations while managing competing priorities and maintaining attention to detail.
• Perform other case coordination, documentation review, and administrative support duties as assigned.

Qualifications

Required

• Experience with Workers' Compensation claims, including adjuster communication, nurse case manager coordination, state fee schedules, authorizations, utilization review, medical documentation, and regulatory requirements.
• Strong understanding of insurance reimbursement, DME operations, medical terminology, HIPAA, appeals, prior authorization, revenue cycle, accounts receivable, case management, and medical documentation.
• Excellent written and verbal communication, negotiation, customer service, relationship management, and conflict resolution skills.
• Strong organization, critical thinking, time management, and problem-solving skills, with the ability to manage numerous complex cases simultaneously.
• Ability to maintain accuracy, professionalism, confidentiality, and timely follow-through while coordinating with multiple stakeholders.

Preferred

• Bachelor's degree in Healthcare Administration, Business, Nursing, Communications, or a related field; equivalent experience considered.
• Three or more years of experience in DME, Workers' Compensation, case management, authorization, reimbursement, or related healthcare operations.