Worker's Comp & VA Claims Specialist

Position Overview

The VA & Workers’ Compensation Authorization Specialist is a hybrid role responsible for managing authorizations, claims processing, and payer communications across two distinct lines of business: the Veterans Affairs (VA) Community Care program and Workers’ Compensation (WC) claims. This position plays a critical role in the revenue cycle and operational continuity of NuLife Med LLC, requiring a professional who can navigate multiple regulatory frameworks, build strong relationships with both VA purchasing agents and WC adjusters, and drive accuracy and compliance across all transactions.

This is a high-impact, dual-function role that represents a core pillar of the organization’s growth strategy. The ideal candidate will bring leadership qualities, strategic thinking, and the ability to manage complex workflows with minimal supervision.

Key Responsibilities

Veterans Affairs (VA) — Community Care Authorization

• Perform Request for Service (RFS) status checks on all assigned VA orders and patients to confirm the RFS is on file with the Veterans Community Care VA office.
• Resubmit Requests for Service as deemed appropriate, ensuring documentation accuracy prior to every submission.
• Conduct research and determine corrective actions, routing RFS files appropriately when issues are identified.
• Respond to VA Purchasing Agents’ Requests for Quotes in a timely manner, typically within one hour of receipt.
• Communicate with VA Purchasing Agents to confirm Purchase Order (PO) issuance and the notification method used to inform IOS.
• Verify the accuracy of Purchase Orders received from VA Purchasing Agents, ensuring all DME is covered and that contracted pricing has been correctly applied.
• Maintain a thorough understanding of the VA Community Care process, including CCN protocols and compliance requirements.
• Organize and maintain official Contracted Order records for each VA inquiry, serving as the authoritative file of record.

Workers’ Compensation — Authorization & Claims Coordination

• Prepare and submit requests for authorization to workers’ compensation adjusters and/or third-party administrators (TPAs).
• Ensure all required documentation is included in each authorization request prior to submission.
• Follow up proactively with adjusters and TPAs to expedite the authorization process and prevent claim delays.
• Build and maintain positive, professional relationships with WC adjusters and TPA contacts.
• Communicate effectively with adjusters and TPAs to provide additional information, clarification, or supporting documentation on claims.
• Maintain accurate and complete records of all WC authorization requests, claim communications, and outcomes.
• Generate internal and external reports on claim status, progress, and final payment resolution.
• Stay current on applicable workers’ compensation laws, regulations, and billing requirements across relevant jurisdictions.
• Ensure compliance with all legal and industry standards in coordination with adjusters, TPAs, and internal leadership.

General Responsibilities

• Handle inbound and outbound telephone calls professionally, demonstrating a comprehensive understanding of each payer’s requirements.
• Exercise sound judgment and decision-making, taking ownership of actions and outcomes.
• Collaborate effectively with cross-functional teams including billing, clinical, and operations.
• Perform other duties as assigned by the Technical Director of Operations.

Requirements

• Strong organizational skills with the ability to maintain accurate, complete, and audit-ready records across multiple payer types.
• Excellent written and verbal communication skills; ability to interact professionally with VA Purchasing Agents, WC adjusters, TPAs, and internal leadership.
• Demonstrated understanding of HIPAA rules and regulations and commitment to patient confidentiality.
• Self-motivated, achievement-oriented team player with proven ability to manage competing priorities and deadlines.
• Ability to respond promptly to time-sensitive requests from multiple payer sources.
• Strong problem-solving, research, and analytical skills.
• Proficient in Microsoft Office Suite (Excel, Word, PowerPoint, Adobe); intermediate level or above.
• Demonstrated skills in project management, negotiation, conflict resolution, and oral/written presentation.

Qualifications

Education

• Bachelor’s degree in Business Administration, Healthcare Administration, Leadership, Management, or a related field strongly preferred.
• Associate’s degree with equivalent combination of directly relevant experience will be considered.
• Coursework or certification in healthcare billing, coding, or compliance is a plus.

Experience

• Minimum 2–3 years of experience in healthcare authorizations, medical billing, DME, or a related healthcare administrative role required.
• Prior experience working with Veterans Affairs, the Community Care Network (CCN), or government healthcare programs strongly preferred.
• Proven experience in workers’ compensation with a focus on authorization submissions and adjuster/TPA collaboration.
• Familiarity with Medicare, Tricare, VA, and insurance billing requirements is highly desirable.
• Established relationships with workers’ compensation adjusters and/or TPAs preferred.
• Ability to work independently while collaborating effectively with cross-functional teams.

Leadership & Professional Competencies

• Demonstrates initiative, accountability, and a solutions-focused mindset.
• Ability to mentor peers, support process improvement, and contribute to departmental leadership goals.
• Strong business acumen with the ability to understand the financial and operational impact of authorization decisions.
• Comfortable operating in a fast-paced environment with evolving regulatory requirements.

Pay: $50,000.00 - $53,000.00 per year

Benefits:

• 401(k)
• Health insurance
• Paid time off
• Prescription drug insurance
• Tuition reimbursement
• Vision insurance
• Work from home

Work Location: Remote