Cala Health

Insurance

• Verify specific DME policy inclusions/exclusions, quantity limits, and "same-or-similar" equipment checks via Medicare portals or other payer portals
• Calculate estimated patient responsibility (deductibles vs. coinsurance)
• If a Prior Authorization is denied, you will initiate an immediate Pre-Service Appeal or "Peer-to-Peer" request to overturn the decision.
• Coordinate referral process between the PCP, prescribing HCP in accordance with insurance requirements.
• Identify what is missing in the clinical notes and coordinate with the doctor's office to rectify it.
• Collaborate with the Revenue Cycle Management team to ensure clean claims.
• Support company goals and objectives, policies and procedures; Adhere to Good Manufacturing Practices and FDA regulations
• Document all interactions into the customer relationship management (CRM) system in accordance with Quality Assurance/Regulatory and HIPAA guidelines
• Perform other duties as assigned

Insurance Verification and Appeals Specialist