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

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
• 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
• Calls back instructors 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
• Arranges delivery of medical equipment to patient’s home
• Maintain inventory tracking of medical equipment
• Researches policies regarding AED Insurance Coverage
• Periodically re-verifies 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

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
• 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
• 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

Address

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

Skills/Experience Preferred

• Familiarity with insurance companies and the duties associated with patient intake information; verification, preauthorization; benefit identification to include coinsurance and deductibles; billing and collection
• Knowledge of home medical equipment

Company Information

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.