Top 8704 Centers for medicare and medicaid services Jobs

Authorization and Appeals Specialist
The Palomino Group —North Carolina
- From $23 an hour
- Full-time
- Background check
- Microsoft Excel
- Microsoft Outlook
- Disability insurance
- Health insurance
Quick Apply
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RCM Supervisor, Client Billing
Radiology Partners —Remote
- $60,000 - $70,000 a year
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MJHS —New York, NY
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Authorization and Appeals Specialist

The Palomino Group
North Carolina

Quick Apply

Job Details

Full-time
From $23 an hour
12 days ago

Benefits

Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Life insurance

Qualifications

Health insurance authorizations
Appeals
Microsoft Excel
Overseeing health insurance pre-certification
Medicare
Phone communication
Medical insurance coverage verification
HIPAA
Administrative experience
Medicaid health insurance
ICD-10
HCPCS
Phone customer support
Case appeal in utilization management
Attention to detail
Health information regulatory compliance
Medical insurance appeals management
Organizational skills
Medicaid
Clinical confidentiality policies
Insurance claims appeal handling
Medical terminology
Technical Proficiency

Full Job Description

Overview

The Authorization & Appeals Specialist will be responsible for conducting benefit and coverage verifications, obtaining authorizations, and supporting the appeal process for medical device procedures. The position will work as part of a reimbursement support team to obtain approval for patient procedures and will mainly interact with health insurance plans, healthcare providers in the physician practice and hospital outpatient settings, and patients. This position requires outstanding knowledge of the reimbursement process associated with outpatient medical procedures, including medical devices. This position requires exceptional written and verbal communication skills with healthcare providers and payers in addition to excellent customer service phone skills. Experience working within portals regarding the digital reimbursement setting is preferred.

A MINIMUM OF 3 YEARS OF AUTHORIZATION AND APPEALS SUPPORT EXPERIENCE REQUIRED.

Responsibilities

The Authorization & Appeals Specialist is responsible for coordinating the reimbursement process for medical device procedures and will work closely with health insurance companies, healthcare providers, and patients. This position requires frequent interaction with healthcare provider teams and requires demonstration of past work success within this or similar environments. Job duties include managing all aspects of the reimbursement and access process, including benefit and coverage verification, prior authorization, and appeals.

The Authorization & Appeals Specialist must be able to:

Understand insurance company processes pertaining to gaining authorization of treatment
Verify medical insurance benefits, including the ability to obtain and process payer forms
Provide information pertaining to claims, including billing and coding assistance
Coordinate authorization for medical device procedures with payer authorization departments
Support the various levels of appeal for denied authorizations or claims
Effectively communicate with healthcare providers on case status
Appropriately answer incoming calls, faxes, and emails through our reimbursement call center
Document all interactions and calls within a case management database
Maintain HIPAA compliance at all times
Expertly translate clinical information into a form letter
Work independently or within a team setting
Provide services in a high-volume and stressful work environment

Required Skill Set

The Authorization & Appeals Specialist must have prior experience in conducting authorizations and appeals for medical procedures and must possess the relevant knowledge of these processes across all payer types, including commercial and public health insurance plans.

Required skills include:

Prior success as an authorization and appeals specialists within the healthcare arena
Outstanding customer service skills (including clarity of voice, tone, empathy, and listening skills)
High level of Professionalism
Strong critical thinking and decision-making skills
Superior written communication skills
Excellent administrative skills
Ability to adapt to different situations
Strong organizational skills
Self-motivation with excellent follow-through skills
Ability to work independently with minimal-to-moderate supervision
Adaptive and flexible to new ideas and change
Proven/demonstrated knowledge of medical reimbursement methodologies
Understanding of HIPAA and legal requirements associated with health information
Fluency in medical terminology

Minimum Qualifications and Experience

3 years of experience conducting benefit and coverage verifications with health insurance plans
3 years of experience in conducting authorizations for medical procedures
3 years of experience in conducting appeals for medical procedures
3 years of health insurance experience working with HCPCS, CPT, ICD-10 codes
Demonstrated familiarity with all payer types (Medicare, Medicaid, Commercial, etc.)
Knowledge of medical procedures, including medical devices used in the outpatient setting
Associate degree or equivalent work experience
Technical Expertise: Working knowledge of Microsoft Office (Word, Excel, Outlook)

If you thrive in a detail-oriented environment with a passion for healthcare authorization and appeals administration, we invite you to bring your skills and enthusiasm to our team!

Pay: From $23.00 per hour

Benefits:

401(k)
Dental insurance
Disability insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Work Location: Remote

Quick Apply

Refine Your Search

centers for medicare and medicaid services jobs

Authorization and Appeals Specialist

Medical Office Staff - Call Center Representative

Patient Account Rep I

Medical Billing Claims Specialist

Medicaid and Medicare Policy Researcher

Member Support Representative Lead

Lead, Payment Poster and Refunds

Healthcare Customer Service Specialist- (REMOTE)

Medicare Member Enrollment Specialist

Healthcare Customer Service Specialist (REMOTE)

Healthcare Customer Service Team Lead (Remote)

Provider Enrollment Specialist

Billing Coordinator

100% Remote RN Care Navigator (Compact License)

Inbound Contact Representative 2

RCM Supervisor, Client Billing

Provider Enrollment Coordinator II

Bilingual Customer Engagement Specialist

Member Services Representative

Outbound Call Center Rep

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