Authorization & Appeals Specialist - Cardio Partners - Remote

Sarnova

15h•Remote

About The Position

The Authorization & Appeals Specialist is responsible for receiving and processing DME referrals, verifying patient eligibility, and coordinating equipment delivery. It involves detailed data entry, insurance interaction, and communication with healthcare providers and patients. The role requires strong administrative, communication, and insurance knowledge to ensure accurate and efficient service delivery. The Authorization & Appeals Specialist plays a critical part in ensuring timely and accurate processing of Durable Medical Equipment (DME) referrals, which directly supports patient care continuity and satisfaction. By managing insurance verifications, authorizations, and appeals, the position helps reduce claim denials and improves reimbursement efficiency. The role also enhances operational coordination across departments, contributing to streamlined workflows and regulatory compliance.

Requirements

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
Must have experience in medical insurance terminology, CPT, ICD coding structures, and billing forms 1500
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
Must possess and show development of outstanding communication, leadership, and situational awareness skills
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
When working remotely, ability to secure confidential information
When working remotely, perform all duties in a professional environment free of noise or anything that would create a negative customer experience

Nice To Haves

Knowledge of home medical equipment is a plus

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 and any other duties as assigned
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
Coordinate Instructor call backs 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
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
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
Additional job duties as assigned