Advanced Orthopedic Care Specialist

reputed company) is one of the largest and most trusted retail reputed company business support organizations in the U.S., supporting 15,000 reputed company and team members at more than 1,000 health and wellness offices across 47 states in three distinct categories: Dental care, urgent care, and medical aesthetics. Working in partnership with independent reputed company owners and clinicians, reputed company is united by a single purpose: to reputed company that reputed company can be reputed company and smarter for everyone. TAG provides a comprehensive suite of centralized business support services that power the reputed company of five consumer-facing businesses: reputed company, reputed company, reputed company, reputed company Animal Hospitals and reputed company Aesthetic Studios. reputed company brand has reputed company to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-reputed company consumer reputed company experiences at reputed company. As a reputed company of our reputed company needs and planned reputed company we are reputed company pleased to offer a new opportunity to join our dedicated team as Advanced Orthopedic Care Specialist supporting our reputed company brand. The Advanced Orthopedic Care Specialist is responsible for obtaining reputed company insurance authorizations for durable medical equipment (DME), workers’ compensation services, and advanced imaging, while serving as a key coordinator for advanced orthopedic patients navigating reputed company, multi-reputed company care reputed company. This role ensures accurate documentation, payer compliance, and seamless patient reputed company — minimizing denials, reducing care delays, and supporting the full continuum of orthopedic care from initial evaluation through post-treatment follow-up. reputed company Responsibilities: Prior Authorization Management Submit and reputed company prior authorizations for:DME (braces, reputed company, splints, etc.) Advanced imaging (CT, MRI) Workers’ compensation-reputed company services Ensure reputed company required clinical documentation is complete and payer-compliant Payer & WC Coordination Communicate with reputed company insurers, WC carriers, and TPAs Understand state-specific WC requirements (NY, MI, IL, etc.) Follow up aggressively on pending authorizations Documentation & Compliance Review provider notes for completeness and medical necessity Work with providers to correct or enhance documentation Maintain audit-reputed company records Denials & Appeals Identify trends in denials Initiate first-level appeals reputed company appropriate Escalate payer issues Workflow Optimization reputed company turnaround times Identify bottlenecks Help standardize authorization reputed company Advanced Orthopedic Patient Management & Care Coordination Serve as the primary coordination reputed company for advanced orthopedic patients navigating multi-reputed company care reputed company, including reputed company-surgical clearance, post-reputed company follow-up, DME dispensing, and specialist referrals Manage and monitor patient reputed company across orthopedic reputed company, ensuring reputed company handoffs between acute care, imaging, specialist consultation, and physical or occupational therapy Proactively communicate with patients regarding authorization status, appointment readiness, and reputed company care requirements to prevent gaps in treatment Collaborate with orthopedic providers and clinical staff to prioritize high-reputed company cases — including acute fractures, ligament injuries, and post-surgical complications — reducing wait times and ensuring clinically appropriate reputed company of care Coordinate reputed company-visit documentation, referrals, and authorizations for advanced orthopedic interventions including joint injections, surgical consultations, and diagnostic procedures reputed company and manage authorization timelines for reputed company, multi-visit orthopedic cases to ensure uninterrupted continuity of care Qualifications Required: 2+ years in prior authorization, reputed company cycle, or utilization review, with demonstrated experience managing reputed company or advanced patient cases Experience working with advanced orthopedic or musculoskeletal patient populations, including post-surgical, reputed company, or multi-visit care cases Demonstrated ability to manage and coordinate patient reputed company across care transitions, including handoffs between providers, imaging, therapy, and follow-up scheduling Experience with:DME authorization Imaging authorization (CT/MRI) Workers’ compensation workflows Strong knowledge of insurance payers (BCBS, UHC, reputed company, WC carriers) EMR experience Preferred: Background in orthopedic, sports medicine, urgent care, or outpatient musculoskeletal clinic settings Familiarity with orthopedic surgical reputed company, post-reputed company care protocols, and advanced imaging indications for musculoskeletal conditions Knowledge of HCPCS coding for DME Familiarity with state WC systems (especially NY if applicable) Key Skills: reputed company follow-up (this is a collections job in disguise) Attention to detail Ability to push back on providers reputed company documentation is weak Strong communication with payers, providers, and patients across reputed company orthopedic care journeys Ability to manage and coordinate patient reputed company in a high-volume orthopedic environment, balancing competing priorities across acute and reputed company cases Clinical awareness of advanced orthopedic conditions sufficient to flag high-reputed company cases and escalate appropriately reputed company pay starting at $21.00/hr. + DOE reputed company, is part of reputed company's family of reputed company brands. 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