Therapy Access Specialist (Contractor)

The Opportunity

The Therapy Access Specialist provides operational support to the Therapy Access organization including, but not limited to, contact patient and healthcare provider for documentation, verify insurance benefits, secure authorizations and other duties, as required. Other duties may include data entry of new patient referrals. This is a contractor (1099) position.

The Specialist requires specific knowledge of health insurance plans, interpretation of benefits and prior authorization protocol. Also, general knowledge of durable medical equipment (DME) coverage landscape is strongly recommended.

Location: Remote, must reside in the United States

Reports to: Associate Director, Therapy Access

Responsibilities

• Effectively and accurately verify active health insurance coverage via phone call with a payor representative.
• Effectively and accurately utilize the payor websites, such as Availity, NaviNet and others, to verify insurance eligibility and submit prior authorizations.
• Ability to communicate in a clear and effective manner, both orally and in writing.
• Ability to maintain confidentiality.
• Document all interactions and calls into the customer relationship management (CRM) system in accordance with Quality Assurance, Regulatory and HIPAA guidelines. Collaborate with Sales Support Representatives to transfer benefit verification and authorization data so the sale is completed accurately and efficiently.
• Data entry of new patient referrals into CRM
• Contact new patient referrals for insurance confirmation.
• Provide telephone and department support, as needed.
• Performs other related clerical duties, as assigned.

Skills and Experience

• 3 to 5 years of medical insurance experience, preferably at a medical company
• Bachelor's degree is strongly preferred; High school diploma or equivalent required

Experience in insurance benefits and eligibility

• Strong computer skills including CRM (Salesforce.com), payor sites, such NaviNet and Availity
• Strong organizational skills and attention to detail
• Strong customer service skills

Physical Demands

• While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, and use hands and fingers to operate a computer, telephone and keyboard
• Specific vision abilities required by this job include close vision requirements due to computer work
• Ability to sit or stand at a desk for extended periods of time, performing tasks such as data entry, document review, speaking on the phone, etc.

Additional information

Applicants must be authorized to work in the United States on a full-time basis, or eligible for work authorization through a sponsorship path that Cala Health is able to support. Sponsorship decisions are made individually based on role, timeline, and cost considerations, and are not guaranteed.

Cala Health believes our success is based on diversity of people, teams and thinking. We offer all employees the tools, training and mentoring they need to succeed.