Our DNA

We're here to empower people to experience greater control over their chronic conditions and more freedom in their daily lives. Our science-first approach and rapid yet rigorous clinical development means we seek excellence in everything we do for customers and our teammates. Inspired by our work, and the talented team members who work with us, we're united in our collective goal to bring about improved, lasting patient outcomes. Join us in building a better future.

The Opportunity

Cala Health is seeking a Collection and Appeals Specialist to join our growing team. The role will report to the Claims Manager. This individual will act as a professional representative of our organization. We are seeking a positive, highly motivated specialist to join our team remotely. In this position, employees will be responsible for reviewing documentation for medical necessity and submission of said documentation.

The overall compensation range for this role is market driven, with a salary range of $80,000 - $100,000. This market range is based on our base compensation. Additionally, we offer Cala Health company stock options and a robust benefits package. This offering is aligned with our overall compensation philosophy.

Responsibilities:

• Review clinical information for all appeals by using criteria that is nationally recognized.
• Prepare review for cases that do not meet the required criteria. Work with the Intake team to ensure quality documentation.
• Coordinate and deliver verbal and written information regarding patient and provider appeal and ensure all letters are in line with all required standards.
• Maintain files and logs related to all appeals
• Coordinate hearings with various internal departments and agencies.
• Stay on top of changes and updates from all payors under your individual responsibilities.
• Answer phone calls and emails pertaining to claims from patients or insurance companies.
• Opening and distribution of mail.
• Request adjustments with detailed explanation when needed
• Request information from physician and/or patients when additional documentation is needed.
• Setup Cala Health's access to payors' portal that Cala interacts with when allowed by the payor.
• Keep all Customer Care teams updated on news from payers or changes in payment activities.
• Report information to the Claims manager issues or non-payment from payers.
• Work Accounts Receivable through the Revenue Cycle Work list; provide a detailed breakdown of all outstanding invoices quarterly to Claims Manager.
• Monitor Brightree system for evidence of lost revenue and/or potential lost revenue to Cala Health and report to management.
• Support new and emerging business models.
• Communicate and work with clients and cross-functional departments to identify potential risks and solutions for performance improvement.
• Perform any other duties, as assigned, when necessary for productivity of the Claims Department.

Qualifications and Experience:

Required:

• Bachelor or Associate Degree in Business or Finance preferred but not required.
• Strong computer skills
• Capable user of Microsoft Office products including Outlook, Excel, and Word.
• Self-starter who takes initiative to overcome challenges
• Excellent written and verbal communication skills
• Must be detail oriented and able to plan, organize and complete tasks in a timely manner
• Ability to multi-task and work independently

Preferred:

• Brightree or Salesforce software knowledge
• At least 2(+) years of DME accounts receivable billing experience (Medicare desired)