Cala Health logo
Cala Health

A bioelectronic medicine company transforming the standard of care for chronic disease.

Insurance Verification and Appeals Specialist

InsuranceInsuranceFull TimeRemoteSeniorTeam 51-200H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

6 days ago

Salary

$68K - $90K / year

Seniority

Senior

Bachelor Degree3 yrs expEnglish

Job Description

• 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

Job 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

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