Advanced Orthopedic Care Specialist

The Aspen Group (TAG) is one of the largest and most trusted retail healthcare business support organizations in the U.S., supporting 15,000 healthcare professionals 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 practice owners and clinicians, the team is united by a single purpose: to prove that healthcare can be better and smarter for everyone. TAG provides a comprehensive suite of centralized business support services that power the impact of five consumer-facing businesses: Aspen Dental, ClearChoice Dental Implant Centers, WellNow Urgent Care, Lovet Animal Hospitals and Chapter Aesthetic Studios. Each brand has access to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-quality consumer healthcare experiences at scale.

As a reflection of our current needs and planned growth we are very pleased to offer a new opportunity to join our dedicated team as Advanced Orthopedic Care Specialist supporting our WellNow Urgent Care brand.

The Advanced Orthopedic Care Specialist is responsible for obtaining timely insurance authorizations for durable medical equipment (DME), workers’ compensation services, and advanced imaging, while serving as a key coordinator for advanced orthopedic patients navigating complex, multi-step care pathways. This role ensures accurate documentation, payer compliance, and seamless patient flow — minimizing denials, reducing care delays, and supporting the full continuum of orthopedic care from initial evaluation through post-treatment follow-up.

Core Responsibilities:

Prior Authorization Management

• Submit and track prior authorizations for:
  • DME (braces, boots, splints, etc.)
  • Advanced imaging (CT, MRI)
  • Workers’ compensation-related services
• Ensure all required clinical documentation is complete and payer-compliant

Payer & WC Coordination

• Communicate with commercial 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-ready records

Denials & Appeals

• Identify trends in denials
• Initiate first-level appeals when appropriate
• Escalate payer issues

Workflow Optimization

• Track turnaround times
• Identify bottlenecks
• Help standardize authorization pathways

Advanced Orthopedic Patient Management & Care Coordination

• Serve as the primary coordination point for advanced orthopedic patients navigating multi-step care pathways, including pre-surgical clearance, post-operative follow-up, DME dispensing, and specialist referrals
• Manage and monitor patient flow across orthopedic visits, ensuring timely handoffs between acute care, imaging, specialist consultation, and physical or occupational therapy
• Proactively communicate with patients regarding authorization status, appointment readiness, and next-step care requirements to prevent gaps in treatment
• Collaborate with orthopedic providers and clinical staff to prioritize high-acuity cases — including acute fractures, ligament injuries, and post-surgical complications — reducing wait times and ensuring clinically appropriate sequencing of care
• Coordinate pre-visit documentation, referrals, and authorizations for advanced orthopedic interventions including joint injections, surgical consultations, and diagnostic procedures
• Track and manage authorization timelines for complex, multi-visit orthopedic cases to ensure uninterrupted continuity of care

Qualifications Required:

• 2+ years in prior authorization, revenue cycle, or utilization review, with demonstrated experience managing complex or advanced patient cases
• Experience working with advanced orthopedic or musculoskeletal patient populations, including post-surgical, fracture, or multi-visit care cases
• Demonstrated ability to manage and coordinate patient flow 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, Aetna, WC carriers)
• EMR experience

Preferred:

• Background in orthopedic, sports medicine, urgent care, or outpatient musculoskeletal clinic settings
• Familiarity with orthopedic surgical pathways, post-operative 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:

• Relentless follow-up (this is a collections job in disguise)
• Attention to detail
• Ability to push back on providers when documentation is weak
• Strong communication with payers, providers, and patients across complex orthopedic care journeys
• Ability to manage and coordinate patient flow in a high-volume orthopedic environment, balancing competing priorities across acute and complex cases
• Clinical awareness of advanced orthopedic conditions sufficient to flag high-acuity cases and escalate appropriately

Hourly pay starting at $21.00/hr. + DOE

WellNow, is part of TAG-The Aspen Group's family of healthcare brands.

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