Authorization and Appeals Specialist The Palomino Group Raleigh, NC Job Details Full-time From $23 an hour 9 hours ago Benefits Disability insurance Health insurance Dental insurance 401(k) Paid time off Vision insurance Life insurance Qualifications Appeals Microsoft Excel Microsoft Outlook 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 Medical billing and coding communication with insurance companies Health information regulatory compliance Medicaid Clinical confidentiality policies Insurance claims appeal handling Medical terminology Technical Proficiency Full Job Description Overview The Authorization & Appeals Specialist will be responsible for 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 and to submit appeals for denials pertaining to patient procedures. The position will mainly interact with health insurance plans and healthcare providers in the physician practice and hospital outpatient settings, as well as with members of the reimbursement team. 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 members of the reimbursement team. 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 and submitting appeals for denials 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 Expected hours: 40.0 per week

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