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Authorization & Appeals Specialist - Cardio Partners - Pembroke Pines, FL
Cardio Partners
Pembroke Pines, KSA
Full Time
Entry
Onsite
4 weeks ago
Insurance VerificationMedical TerminologyData EntryAppeals ManagementMedicareMedicaid
Free
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Insurance VerificationMedical TerminologyData Entry
About the Role
Cardio Partners seeks an Authorization & Appeals Specialist to process DME referrals, verify patient eligibility, and coordinate equipment delivery. The role requires strong administrative and insurance knowledge, including experience with Medicare, Medicaid, and appeals.
Key Skills for This Role
Insurance VerificationMedical TerminologyData EntryAppeals ManagementMedicareMedicaid
Responsibilities
- Review clinical denials including referral, pre authorization, medical necessity, and non covered services
- Draft and submit authorization requests to Health Plan/Medical Director based on clinical documentation
- Perform data entry, answer telephones, and direct calls to appropriate staff
- Verify patient eligibility and coordinate delivery of medical equipment
- Maintain inventory tracking of medical equipment and create patient charts
- Research policies regarding AED Insurance Coverage and periodically reverify Medicaid State Allowable
Requirements
- High School Diploma or equivalent
- Minimum 2 years experience working with insurance companies
- Knowledge of Medicare, Medicaid, HMOs, and PPOs
- Experience with medical insurance terminology, CPT, ICD coding, and billing forms 1500
- Knowledge of home medical equipment is a plus
- Good communication and administrative skills
Full Job Posting
Summary
- The Authorization & Appeals Specialist is responsible for receiving and processing DME referrals, verifying patient eligibility, and coordinating equipment delivery.
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
- Maintains referrals and receives and tracks information regarding changes in client status
- Verifies patient eligibility
- Coordinate Instructor call backs to patients with questions
- Must ensure appropriate patient documentation is received prior to delivering medical equipment
- Arrange delivery of medical equipment to patient’s home
- Maintain inventory tracking of medical equipment
- Research policies regarding AED Insurance Coverage
- Periodically reverifies Medicaid State Allowable
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
- Must be familiar with Insurance companies and the duties associated with patient intake information
- Must have 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
- Superior interpersonal abilities
- 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
Benefits
- Competitive salary, commensurate with experience
- Comprehensive benefits package including 401(k) Plan
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