Top 10 Insurance Claims and Policy Processing Clerks Jobs in Miami, FL

Authorization & Appeals Specialist - Cardio Partners - Pembroke Pines, FL
Sarnova —Pembroke Pines, FL
- Full-time
- Sales
- Writing skills
- HIPAA
- 401(k)
Quick Apply
Pharmacy CSR Bilingual Spanish (Remote, Must Live in Florida)
Molina Healthcare —Miami, FL
- $14.00 - $24.02 an hour
- Full-time
- Remote
- Spanish
- 1 year
- Communication skills
4d
Digital Evidence Specialist
City of Fort Lauderdale, FL —Fort Lauderdale, FL
- $50,667.14 - $78,534.56 a year
- Online Application
- Background check
- Pass drug screening
- Maintenance
- Disability insurance
- Health insurance
Senior Accounting Clerk - Controllers
Florida International University —Miami, FL
- $35,000 - $40,000 a year
- Online Application
- Background check
- Research
- Mid-level
3d
Mailroom Clerk (Miami)
Medusind Solutions —Miami, FL
- From $14 an hour
- Full-time
- Computer literacy
- Medical office experience
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
Member Service Assistant
TROPICAL FINANCIAL CREDIT UNION —Kendall, FL
- Full-time
- Microsoft Outlook
- Ability to walk for extended periods
- Word processing
- Profit sharing
- Paid holidays
Quick Apply
3d
HR Office Manager
Pacific Seafood —Miami, FL
- $60,000 - $72,000 a year
- Full-time
- Spanish
- English
- Mid-level
- Profit sharing
- Paid holidays
Quick Apply
Administrative Assistant/Medical Front Desk
YJW Excellent Care LLC —Miami, FL
- $15 - $18 an hour
- Part-time
- Bilingual
- Microsoft Excel
- HIPAA
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4d
Accounting Clerk - Shaw Ross (Miramar, FL)
Southern Glazer’s Wine and Spirits —Miramar, FL
- $19 an hour
- Full-time
- Computer literacy
- Office
- High school diploma or GED
- Wellness program
- Disability insurance
4d
Office Specialist - Herbert Wertheim College of Medicine
Florida International University —Miami, FL
- $32,150 - $35,000 a year
- Online Application
- Background check
- Pass drug screening
- Research

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Authorization & Appeals Specialist - Cardio Partners - Pembroke Pines, FL

Sarnova -
Pembroke Pines, FL

Quick Apply

Job Details

Full-time

Benefits

401(k)

Qualifications

Insurance third-party billing
Appeals
Customer communication
Medicare
Medical insurance coverage verification
Intake
Overseeing healthcare denial management
Writing skills
HIPAA
Medical coding guidelines
English
Research
High school diploma or GED
Medicaid health insurance
Case appeal in utilization management
Pre-authorization review for utilization management
Medicare regulations
Medicaid regulations
Medicaid
Clinical documentation standards
Medical billing regulations compliance
Insurance claims appeal handling

Full Job Description

Summary:
The Authorization & Appeals Specialist is responsible for receiving and processing DME referrals, verifying patient eligibility, and coordinating equipment delivery. It involves detailed data entry, insurance interaction, and communication with healthcare providers and patients. The role requires strong administrative, communication, and insurance knowledge to ensure accurate and efficient service delivery.

Organizational Impact:
The Authorization & Appeals Specialist plays a critical part in ensuring timely and accurate processing of Durable Medical Equipment (DME) referrals, which directly supports patient care continuity and satisfaction. By managing insurance verifications, authorizations, and appeals, the position helps reduce claim denials and improves reimbursement efficiency. The role also enhances operational coordination across departments, contributing to streamlined workflows and regulatory compliance.

Address:
1911 NW 150th Ave, Suite 201
Pembroke Pines, FL 33028

Essential Duties and Responsibilities:

Review clinical denials including but not limited to referral, pre-authorization, medical necessity, non-covered services
Draft and submit authorization request to the Health Plan/Medical Director based on the review of clinical documentation with Medicare, Medicaid, and third-party guidelines
Performs data entry, answers telephone, and directs calls to the appropriate staff and performs basic clerical duties and any other duties as assigned
Serves as first line of contact for referral client care calls from physician’s offices, and others
Maintains referrals and receives and tracks information regarding changes in client status
Verifies patient eligibility
Coordinate Instructor call backs to patients with questions
Must ensure appropriate patient documentation is received prior to delivering medical equipment; securing a valid prescription, physician written order and physician medical notes
Arrange delivery of medical equipment to patient’s home
Maintain inventory tracking of medical equipment
Research policies regarding AED Insurance Coverage
Periodically reverifies Medicaid State Allowable
Create, organize, and file patient charts
Conduct and record cash sales when working through insurance is not feasible
Supports office operations
Works closely with Nursing coordinator and Instructors from the referring doctor’s office
Additional job duties as assigned

Skills/Experience Required:

Education: High School Diploma or equivalent required
Minimum of 2-years’ experience working with insurance companies required
Knowledge and application of managing and appealing denials
Working knowledge of Medicare, Medicaid, HMO’s, and PPO’s is essential as well as knowledge of HIPAA regulations
Must be familiar with Insurance companies and the duties associated with patient intake information; verification, preauthorization; benefit identification to include coinsurance and deductibles; billing and collection
Must have experience in medical insurance terminology, CPT, ICD coding structures, and billing forms 1500
Knowledge of home medical equipment is a plus
Self-directed and highly motivated with a “can do” attitude
Superior interpersonal abilities; ability to get along with diverse personalities, tactful, flexible
Good communication skills; well-developed administrative skills
Writing and verbal communication skills are required in English
Must possess and show development of outstanding communication, leadership, and situational awareness skills
Ability to work well under pressure in a fast-paced environment with frequently changing priorities, deadlines, and workloads. Strong time management skills
Ability to be objective in discussions and decisions making

Sarnova is an Equal Opportunity Employer. We offer a competitive salary, commensurate with experience, along with a comprehensive benefits package, including 401(k) Plan. EEO/M/F/Veterans/Disabled. Our mission is to be the best partner for those who save and improve patients’ lives. Excellence in delivering upon our mission is dependent upon having a diverse team that is empowered to bring their full, authentic self to work each day. We strive to create a workplace that reflects the communities we serve, and we are passionate about creating an inclusive workplace that promotes and values diversity.

#cardiopartners

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Insurance Claims and Policy Processing Clerks jobs in Miami, FL

Authorization & Appeals Specialist - Cardio Partners - Pembroke Pines, FL

Pharmacy CSR Bilingual Spanish (Remote, Must Live in Florida)

Digital Evidence Specialist

Senior Accounting Clerk - Controllers

Mailroom Clerk (Miami)

Member Service Assistant

HR Office Manager

Administrative Assistant/Medical Front Desk

Accounting Clerk - Shaw Ross (Miramar, FL)

Office Specialist - Herbert Wertheim College of Medicine

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