Authorization and Appeals Specialist

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. This is a remote position; however, some training at our Raleigh, NC facility is required.

A MINIMUM OF 2-3 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
• 2-3 years of experience in conducting authorizations for medical procedures
• 2-3 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

Experience:

• Prior Authorization and Appeals: 2 years (Preferred)

Location:

• Raleigh, NC 27615 (Preferred)

Work Location: Hybrid remote in Raleigh, NC 27615

Salary : $23