Cala Health is hiring an Insurance Verification and Appeals Specialist

Cala Health is hiring an Insurance Verification and Appeals Specialist. In this role, you will be responsible for verifying complex benefits, securing pre-authorizations, and managing pre-service appeals to dispute insurance denials before equipment shipment. Your meticulous work will directly minimize estimated out-of-pocket errors for patients.

What You'll Do

• 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, including deductibles and coinsurance.
• If a Prior Authorization is denied, initiate an immediate Pre-Service Appeal or 'Peer-to-Peer' request to overturn the decision.
• Coordinate the referral process between the PCP and prescribing HCP in accordance with insurance requirements.
• Identify what is missing in 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.

What We're Looking For

• High school diploma or equivalent.
• 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.
• Must be currently authorized to work in the United States on a full-time basis.

Nice to Have

• Bachelor’s degree.

Technical Stack

• MS Office, Google, Internet
• CRM systems
• Medicare portals
• Other payer portals

Team & Environment

This role reports to the Therapy Access Manager.

Benefits & Compensation

• Salary: $68,000 - $90,000
• Robust benefits package

Work Mode

This is a fully remote position open to candidates located within the United States.

Our selection process is driven by the key requirements for the role rather than bias or discrimination on the basis of a candidate’s sex, gender identity, age, marital status, veteran status, non-jobrelated disability/handicap or medical condition, family status, sexual orientation, religion, color, ethnicity, race or any other legally protected classification.