As an Insurance Verification and Appeals Specialist, you will ensure patients can access prescribed therapies by thoroughly reviewing insurance benefits, obtaining necessary pre-authorizations, and managing appeals before service delivery. Your work will directly reduce financial barriers by clarifying coverage details and overturning initial denials through structured appeal processes.
Key Responsibilities
- Review durable medical equipment (DME) policies using Medicare and payer portals to confirm coverage, quantity limits, and equipment equivalency
- Estimate patient financial responsibility by analyzing deductibles, coinsurance, and benefit structures
- Respond to denied prior authorizations by initiating timely pre-service appeals or peer-to-peer reviews
- Coordinate communication between primary care providers and prescribing clinicians to meet payer requirements
- Identify gaps in clinical documentation and work with medical offices to resolve them
- Partner with revenue cycle teams to support accurate claims processing
- Record all patient and payer interactions in the CRM system following regulatory, quality, and HIPAA standards
- Follow FDA guidelines and Good Manufacturing Practices as applicable
- Complete additional tasks in support of organizational policies and objectives
Qualifications
A high school diploma or equivalent is required. Candidates must have at least three years of experience in healthcare, with a focus on Medicare Part B, Medicare Advantage, and commercial insurance processes—including preauthorization and appeals. Proficiency with MS Office, web-based tools, CRM platforms, and payer portals is essential. Strong organizational abilities, attention to detail, and effective time management in fast-moving environments are critical. All applicants must be authorized to work full-time in the United States.
A bachelor’s degree is preferred. Excellent written and verbal communication skills are expected. You must be able to prioritize tasks independently while collaborating across teams.
Compensation and Work Environment
This position offers a salary range of $68,000 to $90,000. The role supports a global work model, allowing flexibility in work location. A comprehensive benefits package is provided.
Commitment to Inclusion
We are committed to building diverse, inclusive teams that reflect a broad range of perspectives. Hiring decisions are based solely on qualifications and role requirements, without regard to sex, gender identity, age, marital status, veteran status, non-job-related disability, sexual orientation, religion, race, color, ethnicity, or any other legally protected status.
