VA & Workers' Compensation Authorization Specialist

Job Overview

Our client is seeking a to manage authorizations, claims processing, and payer communications for Veterans Affairs (VA) and Workers' Compensation (WC) lines of business. This role is critical to the revenue cycle for a provider of essential medical equipment and services, ensuring compliance and strong relationships with VA agents and WC adjusters.

Why This Role Stands Out

• Drive critical revenue cycle operations by managing complex VA and Workers' Compensation authorizations and claims.
• Navigate and ensure compliance with intricate regulatory frameworks including HIPAA, VA protocols, and WC laws.
• Build and maintain essential relationships with VA Purchasing Agents and Workers' Compensation adjusters.
• Achieve full operational autonomy within 90 days, with opportunities to contribute to process improvements.

Who This Role Is For

• A detail-oriented professional adept at navigating complex regulatory environments.
• Someone with a proven ability to manage competing priorities effectively.
• An individual committed to maintaining strict compliance with healthcare and workers' compensation laws.
• A relationship-builder skilled in communicating with VA agents and WC adjusters.
• A proactive problem-solver focused on expediting authorization and claims processes.

What You'll Do

• Perform Request for Service (RFS) status checks for VA orders and patients.
• Resubmit Requests for Service and ensure documentation accuracy.
• Respond to VA Purchasing Agents’ Requests for Quotes within one hour.
• Verify Purchase Orders from VA agents for coverage and pricing accuracy.
• Prepare and submit authorization requests to workers' compensation adjusters and TPAs.
• Follow up proactively with adjusters and TPAs to expedite authorization processes.
• Maintain accurate records of all authorization requests, communications, and outcomes.
• Generate internal and external reports on claim status and payment resolution.
• Ensure compliance with HIPAA, VA protocols, and workers' compensation laws.

What We're Looking For

• Demonstrated experience in Healthcare Authorizations and Medical Billing.
• Proficiency in HIPAA Compliance and related regulatory protocols.
• Strong negotiation skills for payer communications.
• Familiarity with Workers' Compensation Regulations (preferred).
• Ability to quickly learn and adapt to internal systems and workflows.
• Proven track record of managing an independent caseload efficiently.
• Exceptional attention to detail and organizational skills.