Authorization Appeal Specialist

About Us

ForMotion is a global network of Orthotic and Prosthetic Patient Care clinics, focused on providing world-class, compassionate care for patients with mobility challenges.

Our clinic is part of the ForMotion global network of Patient Care clinics owned by Embla Medical, which also owns Össur, a leading global provider of prosthetics and bracing and supports solutions; Fior & Gentz, an innovative developer of neuro orthotics; and College Park, creators of custom-built prosthetic solutions for people of all activity levels.

We are dedicated to providing the best possible care to our patients to help them live Life Without Limitations.

About the Role

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. The Specialist independently researches payer policies, develops case specific appeal strategies, submits complete appeal packages, and communicates appeal status through final determination.

What You’ll Do

• 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.

Who You Are

• 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.

• 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

Why You’ll Feel Good Working Here

We believe people do their best work when they feel good—personally and professionally. That’s why we offer:

• 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. Our salary ranges are determined by role, level, and location. The range displayed on each job posting reflects the minimum and maximum target for new hire salaries. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. Your recruiter can share more about the specific salary range for your preferred location during the hiring process.

Please note that the compensation details listed in US role postings reflect the base pay only, and do not include bonus, equity, or benefits.

ForMotion is a global network of Orthotic & Prosthetic patient care clinics providing exceptional care through award-winning mobility solutions and world-class healthcare professionals.

Important Warning: Beware of fraudulent recruiters impersonating our company. Please take extra caution when asked for any sensitive personal information, such as social security numbers or bank account details. We will never ask you for any form of payment during the recruitment process. Please make sure you refer to our official website .