Insurance Verification and Appeals Specialist
Cala Health
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $68,000 - $90,000 per year
About the role
- 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
Requirements
- Bachelor’s degree is strongly preferred; High school diploma or equivalent required
- Minimum 3 years of experience within the healthcare industry focused on deep understanding of Medicare Part B, Medicare Advantage and Commercial payors guidelines, preauthorization and appeals process.
- Strong organizational skills with attention to detail
- Computer competency including MS Office, Google, Internet, and navigation of customer relationship management (CRM) systems
- Ability to prioritize tasks and manage time effectively in a fast-paced environment
- Excellent written and verbal communication skills
Benefits
- Robust benefits package
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Medicare policyPrior AuthorizationPre-Service Appealclaims processingQuality AssuranceHIPAA complianceGood Manufacturing Practicespatient responsibility calculationclinical documentationinsurance coordination
Soft Skills
organizational skillsattention to detailtime managementcommunication skillscollaborationproblem-solvingadaptabilitycustomer serviceprioritizationinterpersonal skills